Vasculitis secondary to staphylococcal Protein A immunoadsorption (Prosorba column) treatment in rheumatoid arthritis

Objective: Vasculitis is a rare complication of immunoadsorption treatment with staphylococcal Protein A (Prosorba column). The prevalence, clinical characteristics, pathophysiology, treatment, and outcome of vasculitis secondary to immunoadsorption treatment is not known. Methods: The authors describe a 57-year-old woman with rheumatoid arthritis (RA) resistant to methotrexate and etanercept, who developed severe leukocytoclastic vasculitis after the 9th weekly treatment with Prosorba column. She developed rapidly progressive crescentic glomerulonephritis and required treatment with cyclophosphamide and high-dose prednisone. Subsequently, renal function stabilized and RA remitted. Through the literature search and by reviewing information submitted to Cypress Biosciences Inc (manufacturer of Prosorba columns), available world literature on vasculitis secondary to Prosorba column treatment was compiled. Results: Immune complex deposition of staphylococcal Protein A (SPA)/SPA antibodies in the glomeruli precipitated the renal disease in our patient. Twenty cases of vasculitis (calculated prevalence, 1 per 400), 5 with internal organ involvement, have been reported in patients treated with Prosorba column for thrombocytopenic purpura. Seven RA patients treated with Prosorba column developed vasculitis (prevalence, 7 per 400), 3 with internal organ involvement. Conclusions: Vasculitis secondary to staphylococcal Protein A immunoadsorption therapy occurs rarely and appears to be related to development of SPA/SPA antibody immune complexes. Rheumatologists should be aware of this potentially serious complication of the Prosorba column treatment for RA.