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.