Plasma exchange in systemic lupus erythematosus.

Of 20 patients who presented to our hospital with the histologically confirmed diagnosis of SLE, nine met the criteria of presence of both a rapidly progressive disease state and contraindications for conventional therapy required for admission to our plasma exchange programme. Five patients improved; two patients progressed to end-stage renal failure; two patients died as a result of complications of advanced SLE. Severe lupus erythematosus (SLE) is usually treated with a combination of steroids and cytotoxic drugs. Even when treated with high dose therapy some patients develop life-threatening complications, such as renal failure, heart failure and respiratory insufficiency. Moreover, both treatment with high dose of corticosteroids and long lasting cytotoxic therapy may produce troublesome side-effects, including severe infections, gastroduodenal ulcers, bone marrow depressions and lymphomas (1, 2). One of the manifestation of SLE is the presence of antibodies against ds-DNA and ss-DNA. These antibodies can either react with DNA bound to te basement membrane and induce an inflammatory reaction (3), or can form circulating immune complexes which deposit in tissues and may impair the function of lymphocytes or macrophages in the RES (4, 5). The presence of anti-DNA-antibodies appears to be secondary to enhanced B-cell activity along with a depression of suppressor T-cells function proteins mediating the inflammatory process, such as fibrinogen, may deposit in membranes already compromised by the disease. Even though the pathogenic mechanisms operating in SLE are not completely understood, it can be expected, from a theoretical point of view, that the extracorporeal removal of any immunopathogens could improve the disease state.(ABSTRACT TRUNCATED AT 250 WORDS)