Long term administration of tocilizumab improves renal amyloid A (AA) amyloidosis deposition in Familial Mediterranean fever

Inui, Keita; Sawa, Naoki; Suwabe, Tatsuya; Mizuno, Hiroki; Yamanouchi, Masayuki; Hiramatsu, Rikako; Hayami, Noriko; Hoshino, Junichi; Kinowaki, Keiichi; Fujii, Takeshi; Ohashi, Kenichi; Ubara, Yoshifumi

doi:10.1080/24725625.2020.1739193

Cited by 7 publications

(1 citation statement)

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“…In patients with RA, AA-amyloidosis has been considered to be caused by the accumulation of reactive amyloid protein in the kidneys and other organs as a result of continued chronic inflammation for several decades in a state of poor disease activity. It has been reported that continuous suppression of chronic inflammation not only suppresses the progression of the disease, but also eliminates or reduces it from the tissues [12,13]. Our study showed that the number of AA-amyloidosis cases decreased after the introduction of newer antirheumatic drugs, and the number of new cases of AA-amyloidosis has also decreased (Tables 2 and 4).…”

Section: Discussionsupporting

confidence: 60%

Use of biologic agents and methotrexate improves renal manifestation and outcome in patients with rheumatoid arthritis: a retrospective analysis

et al. 2021

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Background and purpose We examined whether advances in treatment strategies from older disease-modifying antirheumatic drugs (DMARDs) to new biologic agents and methotrexate improved renal complications and outcome in patients with rheumatoid arthritis (RA). Methods We reviewed records of 156 patients with RA who underwent kidney biopsy at our institute between January 1990 and December 2019. All patients were assigned to one of three periods: period 1, 1990–1999 (n = 48); period 2, 2000–2009(n = 57); period 3, 2010–2019 (n = 51). Results Membranous nephropathy, nephrosclerosis, AA-amyloidosis, and IgA nephropathy were the four major renal manifestations of RA. AA-amyloidosis was diagnosed by kidney biopsy in 21 patients: period 1, 7 patients (15%); period 2, 10 patients (18%); and period 3, 4 patients (8%). The 4 patients in period 3 were in the years 2010–2014, and no new case of AA-amyloidosis was recorded from 2015 to 2019. In all 21 of the patients with AA-amyloidosis, neither a biologic agent nor methotrexate was administered. Fifteen of the 21 patients required dialysis, and 13 died in periods 1–3 because of amyloid-related cardiac dysfunction less than 2 years after the initiation of dialysis. Two of them are doing well using biologic agent despite dialysis. The remaining three patients who received a biologic agent or methotrexate does not progress to end-stage renal failure. In addition, the other renal complications showing progression to dialysis also decreased over time. Conclusion Advances in treatment strategies have improved renal outcome and reduced mortality in patients with RA.

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Section: Discussionsupporting

confidence: 60%