Hemapheresis in systemic lupus erythematosus

Abstract

The place of plasma exchange in treating systemic lupus erythematosus remains to be discussed. Currently available clinical data suggest that PE may be a useful additional therapy only in certain subsets of some severe lupus manifestations such as CNS involvement, crescentic glomerulonephritis, and lupus vasculitis. Using PE could also be of interest in certain manifestations of the anti-phospholipid syndrome. The conflict between the rapid improvement seen in some biological abnormalities (circulating immune complexes, ds-DNA antibodies) and the lack of obvious parallel clinical benefits remains a field of stimulating investigation. Next to plasma exchange associated with conventional corticosteroid or immunosuppressive therapies, other approaches could be of value such as the synchronization of plasma exchange and cyclophosphamide pulses, or the selective removal of assumed pathogenetic antibodies or immune complexes. Insufficient data are presently available to interpret the results of the former. The latter methods could offer the advantage of more precisely establishing the role of selectively removed substances in the pathogenesis of SLE.