Chronic Rheumatoid Arthritis Complicated by Myeloperoxidase Antineutrophil Cytoplasmic Antibody-Associated Nephritis

Abstract

We report a myeloperoxidase antineutrophil cytoplasmic antibody-positive rheumatoid arthritis patient who developed necrotizing crescentic glomerulonephritis. Steroid therapy was given combined with an immunosuppressant agent, and double-filtration plasmapheresis was started with the aim of removing antibodies from the blood. This therapeutic regimen was found to be useful.

Myeloperoxidase-antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with rheumatoid arthritis: a comparison of patients without rheumatoid arthritis

“…MPO-ANCA-associated CrGN in RA patients developed at younger ages than in those without RA. Previous reports also described MPO-ANCA-associated CrGN with RA in middle-aged or younger adults, especially among Japanese (cases 5, 6, 9-11 in Table 3) [4,5,[8][9][10]. Indeed, it is reported that ANCA-associated CrGN mainly affect elderly patients in a Japanese population-based study [21].…”

“…Rheumatoid vasculitis, the most welldocumented form of RA-related vasculitis, develops in RA with clinically active deforming arthritis and extra-articular lesions [2] but rarely involves the kidney [3]. Recently, there have been several case reports on myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis in patients with RA [4][5][6][7][8][9][10], and some specialists consider it to be a form of RA-related complication [6]. However, its clinical features have not been well characterized.…”

AP-VAS 2012 case report: two patients with rheumatoid arthritis suspected of relapsed microscopic polyangiitis after initiation of dialysis

“…The common renal disorders in patients with RA include amyloid A amyloidosis, membranous nephropathy, mesangial proliferative glomerulonephritis, and drug-induced nephropathy [16]. Although less common, there have been several case reports on MPO-ANCA associated glomerulonephritis in patients with RA [17][18][19][20][21][22][23]. We previously reported that renal dysfunction of MPO-ANCA associated crescentic glomerulonephritis in RA patients showed slower progression compared to typical rapidly progressive glomerulonephritis without RA [8].…”

Crescentic glomerulonephritis with antimyeloperoxidase antibodies developing during the course of IgA nephropathy in a patient with rheumatoid arthritis

“…7 Recently, p-ANCA-positive crescentic glomerulonephritis has been documented sporadically in RA patients. 8,9 IgA nephropathy is the most common form of glomerulonephritis in the world, 10 and the occurrence of IgA nephropathy has been demonstrated in some patients with RA. 3 However, in such cases, it is difficult to be sure whether primary IgA nephropathy occurs during the course of RA, or secondary IgA nephropathy occurs as a form of RA nephropathy.…”