Total lymphoid irradiation therapy in refractory rheumatoid arthritis. Fifteen- to forty-month followup.
Twelve patients with refractory rheumatoid arthritis were treated with total lymphoid irradiation (TLI) to a total cumulative dose of 3,000 rads. Post-TLI morbidity/mortality included 8 patients with xerostomia, 4 with weight loss of greater than 10 kg, 3 with loss of 4 or more teeth, 3 with herpes zoster, 4 with bacterial infection that was fatal in 2, 3 with hypothyroidism, 1 with cutaneous vasculitis, and death from myocardial infarction in 1 patient and cardiorespiratory arrest in another. Ten of the patients were reevaluated 15-40 months (mean +/- SE, 30 +/- 2) after completion of TLI, and significant improvement was noted in several disease parameters including number of swollen joints, duration of morning stiffness, and 50-foot walking time. Blood lymphopenia and a decrease in helper T cells (T4) were also noted. These data suggest that changes in immunoregulation induced by TLI can produce longlasting alterations in rheumatoid arthritis, although adverse effects may limit its efficacy.
D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000209:etiology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000532:radiotherapy*; D001803:Blood Transfusion; D001853:Bone Marrow / Q000276:immunology; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000209:etiology; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology; D007108:Immune Tolerance; D007970:Leukopenia / Q000209:etiology; D008208:Lymphatic System / Q000528:radiation effects*; D008231:Lymphopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D012883:Skin Ulcer / Q000209:etiology; D013601:T-Lymphocytes / Q000528:radiation effects; D013921:Thrombocytopenia / Q000209:etiology; D014987:Xerostomia / Q000209:etiology
D011241:Prednisone