The antirheumatic effects of lymphocyte depletion in rheumatoid arthritis were confirmed in a randomized, double-blind trial. Six patients assigned to lymphapheresis demonstrated statistically significant decrements in counts of active joints, swollen joints, and a graded articular index compared to 6 patients similarly treated by a control procedure restricted to the removal of the volume of plasma incidentally lost during lymphapheresis. All patients treated by lymphapheresis developed lymphopenia, and in 4 the percentage of circulating T cells fell disproportionately by 26-58%. Serum IgM declined by 30% in lymphocyte depleted patients. Despite these changes in measures of cellular and humoral immunity, the mechanism of action of lymphapheresis remains obscure. The magnitude of change in synovitis did not correlate with the absolute numbers of mononuclear cells removed nor with the percent reduction in circulating lymphocytes, T cells, or IgM.
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