Treatment of Intractable Rheumatoid Arthritis with Total Lymphoid Irradiation

Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells In the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweed mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy. (N Engl J Med. 1981; 305:969–76.). TOTAL lymphoid irradiation has been used to treat Hodgkin#x0027; s disease and non-Hodgkin lymphomas for the past 20 years.¹ Few serious side effects have been observed in long-term follow-up studies. There has been no measurable increase in the risk of leukemia or other neoplasms in several hundred patients with Hodgkin#x0027; s disease who were given total lymphoid irradiation without chemotherapy and who had no evidence of recurrence of disease for up to 10 years.^2,3 The incidence of severe viral or bacterial infection or of radiation-induced pneumonitis or enteritis requiring hospitalization is less than 1 per cent.¹ Nevertheless, we have shown that cell-mediated. . .