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Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values.
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
December 1986,
The British journal of radiology,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
October 1981,
The New England journal of medicine,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
January 1982,
Lancet (London, England),
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
January 1981,
International journal of radiation oncology, biology, physics,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
September 1997,
Lancet (London, England),
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
February 1986,
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
January 1990,
Duodecim; laaketieteellinen aikakauskirja,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
February 1987,
The Journal of rheumatology,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
September 1987,
Arthritis and rheumatism,
E H Field, and
S Strober, and
R T Hoppe, and
A Calin, and
E G Engleman, and
B L Kotzin, and
A S Tanay, and
H J Calin, and
C P Terrell, and
H S Kaplan
November 1985,
Arthritis and rheumatism,
