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Reticuloendothelial System (RES) Fc receptor-mediated immune clearance and levels of immune complexes were measured in patients with systemic lupus erythematosus undergoing plasmapheresis. RES clearance defects improved and disease manifestations and levels of circulating immune complexes decreased after plasmapheresis. Patients with initially abnormal reticuloendothelial system function, elevated levels of circulating immune complexes, and active acute illness appeared to respond to plasmapheresis. One patient with normal immune clearance, lacking measureable immune complexes, and manifesting chronic disease remained unchanged. Improvements seen following plasmapheresis were best maintained in patients receiving parenteral cyclophosphamide in the post-pheresis period. The correlation of clinical response, improved RES function, and decreased levels of immune complexes suggests the interaction of the latter two parameters in disease pathogenesis. Plasmapheresis has an important role as a research tool, and may be of clinical usefulness in a small number of patients with serious complications of systemic lupus erythematosus.
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