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Efficacy of Total Lymphoid Irradiation in Intractable Rheumatoid Arthritis: A Double-Blind, Randomized Trial

SAMUEL STROBER, M. D.; AMIR TANAY, M.D.; ELIZABETH FIELD, M.D.; RICHARD T. HOPPE, M.D.; ANDREI CALIN, M.D.; EDGAR G. ENGLEMAN, M.D.; BRIAN KOTZIN, M.D.; BYRON W. BROWN, Ph.D.; and HENRY S. KAPLAN, M.D.
[+] Article and Author Information

Grant support: in part by grants from the KROC Foundation.

▸Requests for reprints should be addressed to Samuel Strober, M.D.; Stanford University Medical Center, Department of Medicine, Division of Immunology, Room S-207; Stanford, CA 94305.


Stanford, California


©1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;102(4):441-449. doi:10.7326/0003-4819-102-4-441
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Twenty-six patients participated in a randomized, double-blind study of the efficacy of total lymphoid irradiation in the treatment of intractable rheumatoid arthritis. All 26 patients, for whom therapy with gold compounds and penicillamine had failed, would ordinarily have been considered candidates for cytotoxic or antimetabolite drug therapy. Thirteen patients randomly assigned to receive full-dose total lymphoid irradiation (2000 rad) and 11 patients assigned to receive control low-dose total lymphoid irradiation (200 rad) completed radiotherapy. Alleviation of joint disease activity was significantly greater in the high-dose group as judged by morning stiffness, joint tenderness, and functional assessment (global composite score) at 3 and 6 months after radiotherapy. The high-dose group had a marked reduction in both T-lymphocyte function and numbers, but this finding was not observed in the low-dose group. Complications seen in the high-dose but not low-dose group included transient neutropenia, thrombocytopenia, pericarditis, and pleurisy.

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