A case of AA amyloidosis associated with rheumatoid arthritis effectively treated with Infliximab

Abstract

We report the case of a 55-year-old Japanese woman with reactive AA amyloidosis associated with rheumatoid arthritis, in which inflammatory disease was completely suppressed with infliximab. Nephrotic syndrome was observed and renal biopsy specimens revealed amyloidosis deposits. Treatment with infliximab normalized the serum amyloid A (SAA) protein level, and subsequently nephritic syndrome disappeared and her creatinine clearance improved. Serial gastrointestinal biopsy specimens showed marked lasting regression of amyloid deposits. Thus treatment with infliximab represents an important therapeutic strategy for AA amyloidosis associated with RA.

Prevalence of gastroesophageal reflux disease symptoms and related factors in patients with rheumatoid arthritis

“…(21) GI amyloidosis in RA, including upper GI lesion, has recently been reported to be improved by treatment with such biologics as infliximab and tocilizumab. (22,23) Since the prevalence of GI amyloidosis was reported around 10% by histological evaluation of stomach and duodenum biopsy, (24,25) patients with upper GI amyloidosis could have been included in our study. Unfortunately, however, we did not perform endoscopy and biopsy in this study, and it is unclear whether such histological disorders as amyloidosis were included and whether they associated with GERD symptoms.…”

Effective Anti-TNF-α Therapy Can Induce Rapid Resolution and Sustained Decrease of Gastroduodenal Mucosal Amyloid Deposits in Reactive Amyloidosis Associated with Rheumatoid Arthritis

“…A retrospective study and several case reports have already indicated that such agents are effective against AA amyloidosis [25][26][27][28][29][30] . A retrospective study and several case reports have already indicated that such agents are effective against AA amyloidosis [25][26][27][28][29][30] .…”

“…Recent studies have indicated the therapeutic potential of anti-tumor necrosis factor-α (anti-TNF) or anti-interleukin 6 (anti-IL-6) agents for AA amyloidosis secondary to inflammatory arthritides, including RA [25][26][27][28][29][30] , but the significance of any improvement in tissue levels has not been fully evaluated.…”

Successful treatment of protein-losing enteropathy due to AA amyloidosis with octreotide in a patient with rheumatoid arthritis

“…Her diarrhea rapidly subsided, but edema was persistent and her serum albumin level did not recover. Next, we empirically tried adalimumab administration, because TNF-blocking agents are the second best choice as they can work fast to control active RA if it is intractable to glucocorticoid, and there were reports that etanercept and infliximab can reduce serum amyloid A levels in RA patients with AA amyloidosis [6,22]. However, there was no immediate response to the TNF-blocking agent.…”