摘要
Background. The treatment of inflammatory leg ulcers complicated by r heumatoi d arthritis (RA), which are unresponsive to conventional care, can be frustratin g. Furthermore, as granulocytes and monocytes (GM) are major sources of inflamma tory cytokines, they have the potential to initiate and perpetuate in-flammato ry skin lesions. Accordingly, a recent study reported the remission of pyoderma gangrenosum following the reduction of activated peripheral blood GM by adsorpti ve apheresis (GMA). Methods. In this clinical study, we applied GMA to three cas es, each with one leg ulcer below the knee and RA. The ulcers had not responded to conventional therapy, including disinfection, dressing, and antimicrobials, a nd therefore were thought to represent inflammatory vasculitic lesions. GMAwas p erformed using a column with a capacity of 335mL, filledwith cellulose acetate b eads that selectively adsorb granulocytes and monocytes/macrophages (Adacolumn). Each patient received one GMA session/week for five consecutive weeks. The dura tion of one session was 60 min, with a flow rate of 30 mL/min. Results. The ulce rs began to recede after two GMA sessions and, by the end of the fifth session, the ulcers in all three patients had healed. No recurrence has been observed up to the time of this report. The treatmentwas well tolerated and no severe sideef fects were observed. Conclusions. GMA, which depletes activated neutrophils and monocytes/macrophages, appears to be effective for inflammatory skin ulcers whic h do not respond to conventionalmedications.
Background. The treatment of inflammatory leg ulcers complicated by r heumatoi d arthritis (RA), which are unresponsive to conventional care, can be frustratin g. Furthermore, as granulocytes and monocytes (GM) are major sources of inflamma tory cytokines, they have the potential to initiate and perpetuate in-flammato ry skin lesions. Accordingly, a recent study reported the remission of pyoderma gangrenosum following the reduction of activated peripheral blood GM by adsorpti ve apheresis (GMA). Methods. In this clinical study, we applied GMA to three cas es, each with one leg ulcer below the knee and RA. The ulcers had not responded to conventional therapy, including disinfection, dressing, and antimicrobials, a nd therefore were thought to represent inflammatory vasculitic lesions. GMAwas p erformed using a column with a capacity of 335mL, filledwith cellulose acetate b eads that selectively adsorb granulocytes and monocytes/macrophages (Adacolumn). Each patient received one GMA session/week for five consecutive weeks. The dura tion of one session was 60 min, with a flow rate of 30 mL/min. Results. The ulce rs began to recede after two GMA sessions and, by the end of the fifth session, the ulcers in all three patients had healed. No recurrence has been observed up to the time of this report. The treatmentwas well tolerated and no severe sideef fects were observed. Conclusions. GMA, which depletes activated neutrophils and monocytes/macrophages, appears to be effective for inflammatory skin ulcers whic h do not respond to conventionalmedications.
