Cytotoxic drug treatment of reactive amyloidosis in rheumatoid arthritis with special reference to renal insufficiency

Abstract

Twenty-two patients with amyloidosis secondary to rheumatoid arthritis were randomised and followed prospectively in order to determine whether treatment with cytotoxic drugs could postpone the development of end-stage renal failure. The diagnosis of amyloidosis was based on albuminuria, amyloid-positive rectal and/or abdominal fat aspiration and/or renal biopsies. Renal function was followed by repeated 51Cr-EDTA measurements of the glomerular filtration rate (GFR). Urinary albumin and serum-creatinine were found unreliable as predictors of renal function. GFR declined more rapidly in the patient group receiving only symptomatic drugs and no cytotoxic drugs (NT-group). After an initial decline, the GFR in the cytotoxic drug treatment group (T-group), mean treatment quotient 79%, levelled off and remained constant for a considerable time. The mean observation time was 45.7 months in the NT-group and 53.5 months in the T-group. Seven out of eleven patients in the NT-group developed end-stage renal disease, compared to two out of eleven patients in the T-group. The cumulative proportion of survivors in the NT-group at 36 and 60 months was 71% and 27% respectively. The corresponding figures in the T-group were 89% and 89%. The difference in favour of the cytotoxic drug-treated group was significant (p less than 0.04).

Rapid and complete resolution of proteinuria due to renal amyloidosis in a patient with rheumatoid arthritis treated with infliximab

“…Although the prognosis in patients with amyloid nephropathy has been considered extremely poor, the course of the disease can be ameliorated by treatments that suppresses acute inflammatory activity. Some patients have benefited from treatment with methotrexate (MTX) (3), azathioprine (AZA) (4), or colchicine (5), but in most cases response has been achieved only with potentially toxic alkylating agents (6,7) that confer risks of infertility, myelosuppression, and carcinogenesis. We report herein a case of RA complicated by renal amyloidosis in which treatment with infliximab was associated with complete resolution of proteinuria and stabilization of the amyloid deposits.…”

Regression of the nephrotic syndrome in rheumatoid arthritis and amyloidosis treated with azathioprine

“…This patient had a history of pulmonary tuberculosis, which was treated less than a year before the onset of proteinuria (12). Ahlmen et a1 (13) performed a prospective, randomized study of 22 patients with RA and amyloidosis and noted a significant postponement in progression to end-stage renal disease and a marked increase in survival in the group that received cytotoxic drugs. The treatment protocol was not uniform: 3 patients were given chlorambucil, 3 were given azathioprine, and 1 was treated with cyclophosphamide.…”

BOOP (Bronchiolitis Obliterans Organizing Pneumonia) and Renal Amyloidosis Secon-dary to Infected Cystic Bronchiectasis

“…Bunlar içinde en eski ve en iyi bilineni klorambusil'dir (14). Sekonder amiloidozda etkili bulunan diğer ajanlar arasında kolşisin, siklosporin A ve diğer alkilleyici ajanların olduğu bildirilmekle birlikte tek bir çalışma dışında, prospektif, kontrollü ve randomize çalış-malar yoktur (15,16 …”