Successful leukocytapheresis therapy in a patient with rheumatoid arthritis on maintenance hemodialysis

  • Keisuke Maeshima
  • Masataka Torigoe
  • Mikako Iwakura
  • Kunitoshi Yamanaka
  • Koji Ishii
Case Report


We report the case of a 44-year-old female undergoing maintenance hemodialysis in whom early-phase rheumatoid arthritis (RA) was successfully treated by leukocytapheresis (LCAP). The effects of prednisone, tacrolimus, and etanercept were limited, but LCAP was highly effective and its efficacy continued even after cessation of LCAP. Moreover, remission was maintained for 2 years after discontinuation of medication. LCAP may be an important treatment option for RA patients with end-stage renal failure who are on hemodialysis.


Leukocytapheresis (LCAP) Rheumatoid arthritis Hemodialysis Drug-free remission 


  1. 1.
    Izumi Y, Tominaga M, Iwanaga N, Huang M, Tanaka F, Aratake K, et al. Twenty-four-week follow-up examination of a leukocytapheresis therapy in rheumatoid arthritis. Mod Rheumatol. 2006;16:20–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Ueki Y, Sagawa A, Tanimura K, Yamada A, Yamamoto K, Tsuda H, et al. A multicenter study of leukocytapheresis in rheumatoid arthritis. Clin Exp Rheumatol. 2007;25:810–6.PubMedGoogle Scholar
  3. 3.
    Hidaka T, Suzuki K, Matsuki Y, Takamizawa-Matsumoto M, Kataharada K, Ishizuka T, et al. Filtration leukocytapheresis therapy in rheumatoid arthritis: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 1999;42:431–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Ohsawa I, Ohi H, Maruyama T, Hamada H, Tomino Y. Leukocytapheresis (LCAP) for the treatment of rheumatoid arthritis on a maintenance hemodialysis patient. Clin Nephrol. 2007;68:121–4.PubMedGoogle Scholar
  5. 5.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Basile C, Montanaro A, Semeraro A. Should low-dose methotrexate therapy be prescribed to dialysis patients? Nephrol Dial Transpl. 2002;17:530–1.CrossRefGoogle Scholar
  7. 7.
    Yamashita M, Natsumeda M, Takasugi K, Ueno A, Ezawa K. Efficacy and safety of tacrolimus treatment for rheumatoid arthritis patients undergoing hemodialysis. Mod Rheumatol. 2008;18:296–300.PubMedCrossRefGoogle Scholar
  8. 8.
    Singh R, Cuchacovich R, Huang W, Espinoza LR. Infliximab treatment in a patient with rheumatoid arthritis on hemodialysis. J Rheumatol. 2002;29:636–7.PubMedGoogle Scholar
  9. 9.
    Hammoudeh M. Infliximab treatment in a patient with rheumatoid arthritis on haemodialysis. Rheumatology (Oxford). 2006;45:357–9.CrossRefGoogle Scholar
  10. 10.
    Sugioka Y, Inui K, Koike T. Use of etanercept in a patient with rheumatoid arthritis on hemodialysis. Mod Rheumatol. 2008;18:293–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Nakamura T, Higashi S, Tomoda K, Tsukano M, Arizono K. Etanercept treatment in patients with rheumatoid arthritis on dialysis. Rheumatol Int. 2010;30:1527–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Iwamoto M, Honma S, Asano Y, Minota S. Effective and safe administration of tocilizumab to a patient with rheumatoid arthritis on haemodialysis. Rheumatol Int. 2011;31:559–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Yoshihara R, Ooyama M, Nakao K, Fujimori A. Pulmonary nocardiosis in a hemodialysis patient with rheumatoid arthritis receiving etanercept. J Jpn Soc Dail Ther. 2010;43:341–6.CrossRefGoogle Scholar
  14. 14.
    Hidaka T, Suzuki K, Matsuki Y, Takamizawa-Matsumoto M, Okada M, Ishizuka T, et al. Changes in CD4+ T lymphocyte subsets in circulating blood and synovial fluid following filtration leukocytapheresis therapy in patients with rheumatoid arthritis. Ther Apher. 1999;3:178–85.PubMedCrossRefGoogle Scholar
  15. 15.
    Hidaka T, Suzuki K, Kawakami M, Okada M, Kataharada K, Shinohara T, et al. Dynamic changes in cytokine levels in serum and synovial fluid following filtration leukocytapheresis therapy in patients with rheumatoid arthritis. J Clin Apher. 2001;16:74–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Yamaji K, Yang K, Tsuda H, Hashimoto H. Fluctuations in the peripheral blood leukocyte and platelet counts in leukocytapheresis in healthy volunteers. Ther Apher. 2002;6:402–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Hidaka T. The mechanism of the efficiency of leukocytapheresis on rheumatoid arthritis. Nihon Rinsho Meneki Gakkai Kaishi. 2011;34:447–55.PubMedCrossRefGoogle Scholar
  18. 18.
    Umekita K, Hidaka T, Ueno S, Takajo I, Kai Y, Nagatomo Y, et al. Leukocytapheresis (LCAP) decreases the level of platelet-derived microparticles (MPs) and increases the level of granulocytes-derived MPs: a possible connection with the effect of LCAP on rheumatoid arthritis. Mod Rheumatol. 2009;19:265–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Sakai Y, Sakai S, Otsuka T, Ohno D, Murasawa T, Munakata K, et al. Efficacy of high-throughput leukocytapheresis for rheumatoid arthritis with a reduced response to infliximab. Ther Apher Dial. 2009;13:179–85.PubMedCrossRefGoogle Scholar
  20. 20.
    Hayashi W, Nishikawa Y, Tominaga T, Takashima H, Terada H, Ueki Y, et al. A case of eosinophilia caused by nafamostat mesilate following leukocytapheresis in a rheumatoid arthritis patient undergoing hemodialysis. Kyushu J Rheumatol. 2006;26:36–40.Google Scholar
  21. 21.
    Nagase K, Fukunaga K, Ohnishi K, Kusaka T, Matoba Y, Sawada K. Detection of specific IgE antibodies to nafamostat mesilate as an indication of possible adverse effects of leukocytapheresis using nafamostat mesilate as anticoagulant. Ther Apher Dial. 2004;8:45–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Sato T, Imamura N, Nozaki K, Ishigaki Y. Treatment of multiple sclerosis with lymphocytapheresis using a leukocyte adsorption column. Nihon Rinsho. 1994;52:3032–7.PubMedGoogle Scholar
  23. 23.
    Onuma S, Yamaji K, Kempe K, Ogasawara M, Ogawa T, Yang K, et al. Investigation of the clinical effect of large volume leukocytapheresis on methotrexate-resistant rheumatoid arthritis. Ther Apher Dial. 2006;10:404–11.PubMedCrossRefGoogle Scholar
  24. 24.
    van der Woude D, Young A, Jayakumar K, Mertens BJ, Toes RE, van der Heijde D, et al. Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts. Arthritis Rheum. 2009;60:2262–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum. 2000;43:22–9.PubMedCrossRefGoogle Scholar

Copyright information

© Japan College of Rheumatology 2013

Authors and Affiliations

  • Keisuke Maeshima
    • 1
  • Masataka Torigoe
    • 1
  • Mikako Iwakura
    • 1
  • Kunitoshi Yamanaka
    • 2
  • Koji Ishii
    • 1
  1. 1.Department of Internal Medicine I, Faculty of MedicineOita UniversityYufuJapan
  2. 2.Department of Internal MedicineNakatsu Daiichi HospitalOitaJapan

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