SU1697817A1 - Method for treating the cases of systemic lupus erythematosus - Google Patents

Abstract

This invention relates to medicine, in particular to rheumatology. The goal is to prolong the remission of the disease while reducing doses of hormones. For this, patients with systemic lupus erythematosus are additionally injected with donor plasma containing allogeneic antibodies directed to the patient's histocompatibility antigens in a dose of 190-220 ml 2-4 times during the course of treatment. This allows increasing the effectiveness of treatment in 85.7% of patients, lengthening the time remission while reducing doses of hormones.

Description

This invention relates to medicine, in particular to rheumatology.

The goal is to prolong the remission of the disease while reducing doses of hormones.

The method is carried out as follows.

Patients with systemic lupus erythematosus (SLE) are additionally injected with donor plasma containing allogeneic antibodies directed to histocompatible antigens and the patient (HLA system) at a dose of 190-220 ml 2-4 times during the course of treatment.

PRI me R 1. B-on S. N. I., 19 years old. He complained of a rash of pink on the face, periodic swelling of the hands, accompanied by fading and blueness of the skin, increased sensitivity to cold, swelling and pain in the knee and small joints of the hands, shortness of breath during exercise, increased fatigue, general weakness.

Sick 8 years. Initially, she was treated for rheumatism, and then for rheumatoid arthritis. Then a diagnosis of systemic lupus erythematosus was made. She took prednisone up to 40 mg per day. During the last 4 years, due to the appearance of changes in the urine analyzes, Azathiprin has taken 100 mg / day. Several courses of treatment with heparin and coratile have been carried out.

On admission: the face is moon-shaped, the erythema on the cheeks is bright, pain is felt during movements in the small joints of the hands. Hands are swollen, cold to the touch Heart sounds are muffled, rhythmic, soft systolic murmur above the tip and the V point Pastos foot Daily diuresis 0,55l

Diagnosis: systemic lupus erythematosus, II degree of activity, subacute course, lupus nephritis, carditis, Raynaud's syndrome, erythema, face, polyarthralgia

Taking into account the low efficacy of previously conducted traditional complex therapy (prednisone 25 mg / day, azothioprine 100 mg / day, heparin 20 thousand IU / day, curanfe

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Tyl - 150 mg / day), three doses were transferred in the amount of 190-220 ml of single-group plasma containing anti-HLA antibodies to the patient's antigens. Transfusion tolerance was good. A decrease in shortness of breath, intensity of staining of skin lesions was noted, pains in the border ceased to bother, joint pains and general weakness decreased, and limb pastosity was eliminated. Daily diuresis increased to 1.2 liters. At discharge in the urine analysis: protein 0.15 g / l, er.-single leuke. 6-10 in the visual field, daily proteinuria 0.24 g. The patient was transferred to outpatient treatment at a daily dose of prednisolone 20 mg.

PRI me R 2, B-nd Bn I., V., 30 years old, On admission to the rheumatology department he complained of pain in the joints: mainly in the right hip and 111 fingers of the left foot, aggravated by walking , swelling on the face and legs, hemorrhagic rashes on the legs, general weakness, decreased performance.

Pain since 1982, when erythematous rashes on the face first appeared.

SLE was diagnosed, corticosteroids up to 25 mg of prednisolone per day with good effect and cytosthetics were prescribed. Since that time, it has constantly taken prednisolone 15-20 mg / s., T, and azathioprine 50-100 mg / day. Repeatedly received courses gzparin and chimes. this deterioration is about 2 months.

Admission: face moon-shaped, eyelid swelling and under the eyes, erythema of the face. Axillary and posterior cervical lymph nodes are enlarged to the size of beans. Movement in the right hip joint is limited and painful. Dry gangrene III toe of the left foot without clear limitation. In the lungs, visual breathing. Heart sounds are muffled, rhythmic, systolic murmur over all points. Pulse - 88 beats per 1 min, blood pressure - 130/90 mm Hg. St ,, Multiple striae on the skin of the anterior abdominal wall. The abdomen is soft, moderately painful in the epigastric region. The liver and spleen are not enlarged, swelling of the legs and feet. On the skin of the legs there are hemorrhagic rashes of various sizes.

Diagnosis: - SLE, I degree of activity, subacute course, nephritis, hemarrhagic vasculitis, lymphadenopathy, myocardiodystrophy. Suha Gangrega III toe of the left foot. Secondary deforming coxarthrosis on the right against the background of pronounced osteoporosis.

Taking into account the adverse side effects of long-term use of corticosteroids (aseptic necrosis of the head of the right femur and secondary coxarthrosis)

while receiving prednisone 15 mg per day, azathioprine 50 mg / day, heparin 20 thousand RD. per day, chimes 150 mg / day and symptomatic therapy 4 plasma transfusions containing anti-HLA were performed

0 antibodies to histocompatibility antigens of the patient. After the first two transfusions, a rise in temperature to 37.8 ° C was observed, accompanied by a slight chill. At the same time, the 2nd transfusion had

5 very good diuretic effect with a rapid convergence of edema, which made it possible to completely cancel the diuretics, the 3rd and 4th transfusions patient transfer well. The condition improved significantly - pain in the third toe of the left foot disappeared, the area of necrosis of the finger was clearly limited by the granulation shaft, the swelling was completely eliminated, the diuresis was restored, the erythematous discharge on the face diminished and the hemorrhagic rash on the legs decreased, and the working capacity increased. At the end of the transfusion therapy, diurnal diuresis increased by 2 liters, and the protein in the daily urine decreased to 2.6 g. When urine was taken, urinalysis was complete: protein 0.9 g / l, er., 0-2 unit, leuke. 3-5 in the field of vision.

In satisfactory condition, the patient was discharged from the hospital with a maintenance dose of prednisone 12.5 mg / day and

5 azathioprine 50 mg / day. At the control examination after half a year, the state remains satisfactory, takes 10 mg of prednisone and 50 mg of azathioprich per day and 40 mg of furosemide once a week,

0 Thus, the inclusion in the complex therapy of patients with SLE, along with corticosteroids, and mm depressants, anticoagulants and antiaggregants of single-group transfusions in ABO and

5 Rh-Hr of blood plasma containing aplogenic antibodies to histocompatibility antigens (HLA system), expressive on the patient's body, improves treatment efficiency in 85.7%

0 patients. This is confirmed by an increase in diuresis, a decrease in edema syndrome, skin and joint manifestations of the disease, a decrease in proteinuria and the normalization of laboratory signs of the activity of the process. It is important to emphasize that therapies of patients according to the proposed method allowed to stabilize the process and reduce the average daily dose of corticosteroids in the data patients for a 3-4 week inpatient treatment period.

The observation period for patients for whom the proposed method for treating SLE was first applied was more than 2.5 years. Of the 7 patients observed during this time, 4 patients maintain sufficiently stable clinical and laboratory stabilization of the process at minimal maintenance doses of drugs, while in previous years the patients were treated 1-2 times a year with exacerbations hospital

Claims (1)

The method of treating systemic lupus erythematosus, including immunocorrective and corticosteroid therapy, characterized in that, in order to prolong the remission of the disease by reducing doses of hormones, donor plasma containing allogeneic antibodies directed to the histocompatibility antigens of the patient in a dose of 200-220 is administered 2-4 times during the course of treatment.