Total Lymphoid Irradiation in Tertiary Care for Rheumatoid Arthritis

Excerpt

Recalcitrance of the disease or the emergence of unacceptable drug side effects eventually make some patients with rheumatoid arthritis unsuitable for all medications, including gold or penicillamine, currently approved by the Food and Drug Administration for the management of that disease. In such patients, the physician currently has few options at the tertiary level of care to alleviate morbidity and slow further joint destruction. Ongoing research is directed to evaluating the use of lymphoplasmapheresis (1), leukapheresis (2), methotrexate (3), and fractionated total lymphoid irradiation (4, 5) for refractory patients. A recently completed, multicenter controlled trial (3) and a randomized crossover