title: High-dose immunoglobulin therapy as an immunomodulatory treatment of rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the efficacy of high-dose intravenous immunoglobulin (IVIg) in the treatment of refractory rheumatoid arthritis (RA).
  
  
  METHODS
  Ten patients with active, severe RA that was unresponsive to first- and second-line agents were administered IVIg monthly, for 6 months.
  
  
  RESULTS
  Following IVIg treatment, there was significant improvement in both subjective and objective parameters of disease activity in all 9 patients who completed the protocol. This improvement was noted to occur as early as after the second infusion of IVIg. After discontinuation of the treatment, all patients had a relapse of the disease within a few weeks.
  
  
  CONCLUSIONS
  Since the reduction in clinical activity paralleled a decrease in the CD4+CDw29+:CD4+CD45RA+ cell ratio, some of the therapeutic benefits associated with IVIg may be due to a direct influence on the CD4+CD45RA+ subset. Although the possibility of carrying out further controlled studies on a larger scale is limited by the high cost of the treatment, IVIg appears to be an effective therapy for refractory RA.
authors.affiliation: Second Department of Medicine, Ospedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Tumiati
authors.forename: P
authors.initials: P
authors.lastname: Casoli
authors.forename: M
authors.initials: M
authors.lastname: Veneziani
authors.forename: G
authors.initials: G
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000628:therapy*; D015704:CD4 Antigens / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007116:Immunization, Passive; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D017493:Leukocyte Common Antigens / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D016176:T-Lymphocyte Subsets / Q000276:immunology
chemical_list: D015704:CD4 Antigens; D016756:Immunoglobulins, Intravenous; D017493:Leukocyte Common Antigens