RESEARCH - Vasculitis secondary to Prosorba column treatment in RA

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Semin Arthritis Rheum. 2002 Aug;32(1):3-9.

Vasculitis secondary to staphylococcal Protein A immunoadsorption (Prosorba

column) treatment in rheumatoid arthritis.

Deodhar A, E, Daoud K, Wahba I.

Division of Arthritis and Rheumatic Diseases, Oregon Health & Science

University, Portland, OR 97201, USA. deodhara@...

OBJECTIVE: Vasculitis is a rare complication of immunoadsorption treatment

with staphylococcal Protein A (Prosorba column). The prevalence, clinical

characteristics, pathophysiology, treatment, and outcome of vasculitis

secondary to immunoadsorption treatment is not known. METHODS: The authors

describe a 57-year-old woman with rheumatoid arthritis (RA) resistant to

methotrexate and etanercept, who developed severe leukocytoclastic

vasculitis after the 9th weekly treatment with Prosorba column. She

developed rapidly progressive crescentic glomerulonephritis and required

treatment with cyclophosphamide and high-dose prednisone. Subsequently,

renal function stabilized and RA remitted. Through the literature search and

by reviewing information submitted to Cypress Biosciences Inc (manufacturer

of Prosorba columns), available world literature on vasculitis secondary to

Prosorba column treatment was compiled. RESULTS: Immune complex deposition

of staphylococcal Protein A (SPA)/SPA antibodies in the glomeruli

precipitated the renal disease in our patient. Twenty cases of vasculitis

(calculated prevalence, 1 per 400), 5 with internal organ involvement, have

been reported in patients treated with Prosorba column for thrombocytopenic

purpura. Seven RA patients treated with Prosorba column developed vasculitis

(prevalence, 7 per 400), 3 with internal organ involvement.

CONCLUSIONS: Vasculitis secondary to staphylococcal Protein A

immunoadsorption therapy occurs rarely and appears to be related to

development of SPA/SPA antibody immune complexes. Rheumatologists should be

aware of this potentially serious complication of the Prosorba column

treatment for RA. Copyright 2002, Elsevier Science (USA). All rights

reserved.

PMID: 12219317

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ct & list_uids=12219317

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