Rheumatology
“Rapid removal of antibodies is crucial in patients at high risk of organ dysfunction due to elevated antibody titers and severe symptoms associated with immunological disorders”.
ANCA-associated vasculitides (AAV) are disorders of small blood vessels characterized by positivity for pathogenic ANCA antibodies (anti-neutrophil cytoplasmic antibodies). They involve chronic and relapsing symptoms of varying severity, primarily including granulomatosis with polyangiitis (Wegener’s granulomatosis) and microscopic polyangiitis. The main consequence of vasculitides is vascular integrity loss, leading to blood flow interruption and tissue damage. Organs commonly affected include kidneys, upper respiratory tract, lungs, as well as the nervous system, skin, musculoskeletal system, heart, eyes, and intestines. Treatments range from corticosteroids, monoclonal antibodies, to plasma exchange, culminating in kidney transplantation in severe cases.
Molecules to remove: ANCA (anti-neutrophil cytoplasmic antibodies), predominantly IgG
Recommended Therapies: Plasma Exchange (PEX), Double filtration plasmapheresis (DFPP), Cascade Filtration (CF)
Rheumatoid arthritis is a chronic systemic autoimmune disease primarily affecting joints, with its pathophysiology mediated by cytokines, chemokines, and metalloproteinases, impacting approximately 1% of the population. It is characterized by symmetric inflammation of peripheral joints, progressive joint damage, often accompanied by systemic symptoms. Treatment involves administration of disease-modifying antirheumatic drugs (DMARDs) to control symptoms and slow disease progression, along with plasma exchange and occasionally surgical interventions.
Molecules to eliminate: Rheumatoid factor (IgG portion), IgM
Recommended Therapies: Plasma Exchange (PEX), Double filtration plasmapheresis (DFPP), Cascade Filtration (CF)
Systemic lupus erythematosus (SLE) is a chronic multisystemic inflammatory autoimmune disease that predominantly affects young women. It is triggered by unknown environmental factors that induce autoimmune reactions in genetically predisposed individuals. Common manifestations may include arthralgia and arthritis, Raynaud’s phenomenon, malar rash, and other skin eruptions, pleuritis or pericarditis, renal involvement, or central nervous system manifestations, and hematologic cytopenias. Treatment of severe active disease requires the use of corticosteroids, immunosuppressants, and plasma exchange.
Molecules to remove: Antinuclear antibodies, Inflammatory Mediators
Recommended Therapies: Plasma Exchange (PEX), Double filtration plasmapheresis (DFPP), Cascade Filtration (CF)