Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Miscellaneous Medical Treatment→ Abstract #65

THE USE OF THE STAPHYLOCOCCAL A IMMUNOADSORPTION COLUMN (PROSORBA) TO TREAT SEVERE, TREATMENT RESISTANT JUVENILE RHEUMATOID ARTHRITIS

B. E. Ostrov,¹ B. P. Groh,¹ R. E. Domen.¹

¹Pediatrics and Internal Medicine, Penn State, Milton S. Hershey Medical Center, Hershey, PA; ²Pediatrics, Penn State, Milton S. Hershey Medical Center, Hershey, PA; ³Internal Medicine, Penn State, Milton S. Hershey Medical Center, Hershey, PA

Rheumatoid arthritis (RA) and Juvenile Rheumatoid Arthritis (JRA) are quite variable in severity and outcome. Seropositive and persistent systemic JRA subgroups often respond poorly to standard treatments with non-steroidal antiinflammatory agents and disease modifying agents (DMARDs). In some JRA patients, the response to biologic response modifiers (BRMs) is also suboptimal. Infections may contraindicate the use of both DMARDs and BRMs. The Staphylococcal A Immunoadsorption Column (Prosorba PC) has been approved for treatment of immune thrombocytopenia purpura (ITP) and refractory RA. PC has been shown to bind IgG and immune complexes. We present our experience using PC to manage severe, treatment resistant JRA. All parents and patients gave informed consent. Twelve weekly treatment sessions were planned. Sessions could be terminated on request. A total of 1250 cc of plasma was processed at each session. Laboratory parameters including blood counts, chemistries, serologies and immunoglobulins were assessed.
Three JRA patients ages 14, 16 and 18 years received PC apheresis: two with systemic JRA, and one with RF + poly JRA. Two had failed multiple DMARDs and a BRM. One had to discontinue DMARDs related to chronic infection. The latter patient discontinued PC treatment after 6 sessions, whereas the other two completed 12 sessions. None of the three experienced significant side effects. The poly JRA patient achieved partial disease control and cleared his infection. One systemic JRA patient achieved a long term remission, while the other worsened clinically despite a decrease in erythrocyte sedimentation rate.
The use of PC to treat severe RA has resulted in a 40-50% response rate, sometimes lasting for up to 2 years (Ther Apher. 2000;4:363). Given our initial response rate of 2/3, we believe that PC should also be considered an option to manage severe, treatment resistant JRA.