A marked decline in the incidence of renal replacement therapy for amyloidosis associated with inflammatory rheumatic diseases – data from nationwide registries in Finland

Abstract

Risk for amyloidosis in rheumatic diseases is associated with a long-lasting inflammation. To assess possible changes in the incidence of terminal uraemia due to amyloidosis associated with rheumatic diseases on a nationwide basis, we scrutinised the files of the Finnish Registry for Kidney Diseases for patients suffering from amyloidosis associated with rheumatoid arthritis (RA), ankylosing spondylitis (AS) or juvenile idiopathic arthritis (JIA) over the period 1995-2008. The registry has an estimated 97-99% coverage of all patients accepted for renal replacement therapy (RRT) in the country. Data on the consumption of antirheumatic drugs were collected from two sources: the Social Insurance Institution's Drug Reimbursement Register, and the Sales Register of the National Agency for Medicines from the above period. Altogether 264 cases were identified. Two hundred twenty-nine of them had RA, 15 AS and 20 JIA. When the total annual number of new admissions to RRT varied between 20 and 37 at the end of 1990s, it was under half of that from 2002 onwards. Over this period, the number of users of low-dose methotrexate (MTX) has increased 3.6-fold, the drug being the most frequently used disease modifying anti-rheumatic drug in Finland. The present nationwide series is the first to show that the incidence of end-stage renal disease due to amyloidosis associated with rheumatic diseases is decreasing. An obvious reason for this is intensive anti-rheumatic drug therapy.

A Molecular History of the Amyloidoses

“…Thus, better treatments for rheumatoid arthritis and disorders of pyrin-associated pathways (e.g., familial Mediterranean fever and related disorders) utilizing biologics targeting either cytokines or their receptors have markedly reduced the incidence of AA as a consequence of these conditions. [122][123][124] The apparent uniqueness of the process of amyloidogenesis related to TTR deposition, in which the monomer aggregation precursor concentration is increased in the absence of increased synthesis or aberrant processing (J. Kelly, this volume), has allowed TTR-specific approaches to therapy and possible prophylaxis. Since 1990, the standard therapy for this disease has been liver transplantation.…”

AA Amyloidosis: Pathogenesis and Targeted Therapy

“…In a Finnish report from 1985, over a period of 10 years, approximately 9% of 1,000 individuals with RA died from renal amyloidosis (50). With the increasingly active and successful treatment of chronic autoimmune diseases, including RA, with modern drugs such as tumor necrosis factor (TNF) receptor and interleukin (IL)-6 blockers (51), AA amyloidosis has become rare in the western world (52,53). In some parts of the world, a high incidence of AA amyloidosis persists (54), indicating that AA amyloidosis is unlikely to disappear altogether.…”

AA Amyloidosis in a Cohort of 128 Patients with Takayasu's Arteritis

“…Chronic infections, such as tuberculosis and osteomyelitis, have long been the most common causes of AA amyloidosis while today they are more relevant only in certain developing countries [4]. The incidence of AA amyloidosis in patients with rheumatoid arthritis and ankylosing spondylitis is also decreasing as a result of earlier and more aggressive treatment with disease modifying antirheumatic drugs and biologic agents [5].…”