Prosorba and rheumatoid arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The Prosorba column is a unique treatment for patients with RA who have failed all other conventional therapies.

The column is actually a filter that looks like an oil filter or soup can. The filter contains silica (sand-like material) and Protein A.

A patient has intravenous lines placed in both arms. One line leads out to the filter. A patient’s blood is pumped to a special machine that separates red blood cells from plasma. The plasma is then run through the Prosorba column. Destructive antibodies are removed from the plasma. The clean plasma is recombined with the red blood cells and the “good” blood is then returned to the patient via an intravenous line attached to the patient’s other arm. In effect, this is similar to dialysis.

A patient receives one treatment a week for twelve weeks. Each treatment lasts about two hours.

Potential side effects include flu like symptoms, short term flare of arthritis, and possibly a drop in blood pressure. Patients taking blood pressure medicines called ACE inhibitors are particularly at risk for low blood pressure. Sometimes giving a patient extra fluid during the treatment can help prevent some of these side effects.

Also, in patients with poor venous access, an indwelling port needs to be installed and the potential for infection exists.

It may take several weeks to months to notice a benefit. Patients who do respond will generally experience relief lasting six to twelve months.

Prosorba column treatment may be repeated if effective.

Since Prosorba is available mainly in a hospital setting and many hospitals do not have experience with Prosorba, it is difficult to obtain for many patients. In 2005, regulatory changes made it feasible for patients to receive Prosorba in a physician’s office.

Patients who probably shouldn’t receive Prosorba are patients with a history of significant heart disease or stroke, a history of blood clots, pregnant women, and people who are dependent on ACE inhibitors.

While cumbersome, it is worthwhile trying in patients who have failed other therapies.

Prosorba treatment has fallen by the wayside with the influx of new biologic therapies. The arduous work involved in the treatment has made it less desirable.

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