Role of apheresis in rheumatoid arthritis.

Apheresis, a therapeutic procedure that has been available for decades, has recently been added to the long-term management of rheumatoid arthritis (RA). It is a procedure whereby blood is removed from the body and divided into its various components. With the development of specific instrumentation, it has become possible to target the specific cellular or humoral components to be removed or altered. RA is a destructive, chronic progressive disease with high morbidity and significant mortality if it is not treated. Recently, combinations of disease-modifying pharmacotherapeutic agents have successfully been brought to bear on this serious disease. This approach of combining potent anti-inflammatory, disease-modifying antirheumatic drugs (DMARDs), chemotherapy and biologicals continues with some success but not without significant dangers of severe adverse toxicity, including the risks of sepsis, immunopathology and malignancy. In the setting of RA, various apheresis procedures, with and without these combination modalities, have been tested with variable success. This article reviews that experience as an overall approach to better, safer RA disease management.