Oral heparin in the treatment of rheumatoid arthritis.

Heparin was administered orally in 10 patients with rheumatoid arthritis. The treatment resulted in clinical improvement in all cases (significant reduction in the number of tender and swollen joints and morning stiffness). This was associated with a decrease in erythrocyte sedimentation rate (8/10 patients) and cholesterol in all patients, although the differences were not significant. Recent data indicate that heparin can bind cytokines with potent immune modulatory action (e.g. TNF-alpha, interferon gamma etc.). Thus, neutralization of their action on target cells could be partially responsible for the beneficial effects reported. Moreover, heparin inhibits T cell traffic to a site of antigen by blocking enzymes digesting the extracellular matrix and interfering with selection activity. The results of our preliminary study suggest that heparin, given per os, may have immunomodulatory properties with potential application in human disease.