Clinical improvement in a patient with severe rheumatoid arthritis and chronic hepatitis B after prosorba column immunoadsorption: a one-year followup.

Abstract

New treatments have recently been developed for patients with rheumatoid arthritis (RA) who have not been helped by conventional disease-modifiying antirheumatic drugs (DMARDs). Medications that neutralize tumor necrosis factor (TNF) are used in the treatment of refractory RA. However, anti-TNF agents cannot be used in cases of chronic infection. The presence of circulating immune complexes (CIC) and autoantibodies provides the rationale to try apheresis in RA. Plasma exchange has only limited effects in the treatment of RA (1), but Staphylococcus protein A columns (Prosorba) seem to be a more interesting procedure. Prosorba columns are a specific immunoadsorption device using Staphylococcal protein A to bind immunoglobulin G (IgG) and CIC. In 1987, the Food and Drug Administration (FDA) approved Prosorba columns to treat idiopathic thrombocytopenia purpura (ITP) and in 1999, severe RA. However, very few data with a short followup are available in this indication. We report our experience in a patient with RA and chronic hepatitis B (HBV) who was treated by protein A immunoadsorption. To our knowledge, this is the first description of HBV load evolution after Prosorba column immunoadsorption. Of interest, HBV load decreased and remained low after a series of 12 immunoadsorption sessions. Case report