Hotline Archive - Treatment of Rheumatoid Arthritis by Immunization with Mononuclear White Blood Cells: Results of a Preliminary Trial
February 1996
In the February issue of the Journal of Rheumatology, Drs. J. Bruce Smith and John G. Fort, from Jefferson Medical College, reported the results of an open label trial by immunization with allogeneic mononuclear cells from donors injected at approximately six-week intervals into 11 patients with rheumatoid arthritis.
The patients were all women between the ages of 25 and 60. They had been off disease modifying anti-rheumatic drugs for a six-week washout period. They were allowed to continue non-steroidal anti-inflammatory drugs or prednisone less than 10 mg daily.
Patients received mononuclear cells from their spouse or an individual chosen by the patient, and the same patient-donor pairs were used throughout the study. Statistically significant improvement was noted when pretreatment data was compared to data obtained at the time the third injection, which varied between 10 and 20 weeks depending on the patient.
When all variables were averaged, six of 11 patients experienced greater than 20 percent improvement, and three of 11 experienced greater than 40 percent improvement. Side effects reported were transient local pain and swelling at the subcutaneous injection sites.
The precise mechanisms whereby mononuclear blood cells may be efficacious in rheumatoid arthritis are unclear, but the investigators theorized that in pregnancy, remission of rheumatoid arthritis may occur in part from allogeneic challenge to the maternal immune system. The investigators theorize that exposure to alloantigens could induce a similar effect on non-pregnant patients with rheumatoid arthritis.
Although these results are clearly of interest, this was an open study and was limited in the number of patients being treated. As in any preliminary study for the treatment of rheumatoid arthritis, enthusiasm must always be tempered. A placebo controlled randomized trial with a larger number of patients is needed to confirm these observations. This is a novel form of therapy and, hopefully, future studies will corroborate its benefit.
William Ginsburg, MD
Robert Thoburn, MD
Co-editors, ACR Hotline
Feb. 13, 1996
The Hotline is provided by the American College of Rheumatology Communications and Marketing Committee as an information service for members. This Hotline does not represent a position statement of the College.
Patient Information
Treatment of Rheumatoid Arthritis by Immunization with White Blood Cells: Results of a Preliminary Trial
In the February 1996 issue of the Journal of Rheumatology, investigators from Jefferson Medical College reported the results of a study of immunotherapy using white blood cells (WBC) from donors injected at approximately six week intervals into patients with rheumatoid arthritis (RA).
All patients were women between the ages of 25 and 60. They were allowed to continue on nonsteroidal anti-inflammatory drugs or low-dose prednisone. Disease activity measurements were taken before entry and at time of subsequent immunotherapy injections. Patients received mononuclear WBCs from their spouse or individuals of their choice.
Statistically significant improvement was noted by the third injection, which varied between 10-20 weeks. Six of 11 patients experienced greater than 20 percent improvement, and three of 11 experienced greater than 40 percent improvement. Side effects reported were transient local pain and swelling at the subcutaneous injection sites.
The investigators concluded that injections of mononuclear WBCs may benefit some patients with rheumatoid arthritis. They suggested that a placebo controlled randomized trial immunizing with a standard number of cells will be necessary for the future.
It is unclear why this therapy seems to be helpful, but the investigators theorize that in pregnancy, remissions or improvement in RA may occur in part from the fetal cell challenge to the maternal immune system. Similarly, the foreign WBCs from the donor could induce improvement in nonpregnant patients with RA.
As with any preliminary study, enthusiasm must be tempered. Though these findings are clearly of interest, further studies are necessary using a larger number of patients and having a control group that receives placebo injections. This is a novel form of therapy and, hopefully, future studies will corroborate its benefit.
William Ginsburg, MD
Robert Thoburn, MD
Co-editors, ACR Hotline
Feb. 13, 1996
The Hotline is provided by the American College of Rheumatology Communications and Marketing Committee as an information service for members. This Hotline does not represent a position statement of the College.
