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

Abstract

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.

Endothelial Damage-dominant Nephritis Related to IgA Vasculitis after 11 Years' Use of Infliximab for Rheumatoid Arthritis

“…The mean duration of treatment before development of vasculitis was 34.5 months ( 9 ). The relationship between IgA vasculitis and TNFα inhibitors should be given focus in future studies of RA patients ( 1 ).…”

“…Until the early 2000s, treatment of rheumatoid arthritis (RA) was known to cause renal complications, such as membranous nephropathy ( 1 ). Thereafter, biologics, e.g.…”

“…tumor necrosis factor alpha (TNFα) inhibitors and humanized anti-interleukin (IL)-6 receptor antibody, started to be used for RA, and the details of kidney damage in RA patients consequently changed, as vasculitis related to TNFα inhibitors became a new complication ( 2 ). Furthermore, AA amyloidosis became treatable ( 1 , 3 ).…”

Successful treatment of coexisting membranous nephropathy and immune thrombocytopenia by eradicating gastric Helicobacter pylori infection: a case report

“…Furthermore, capillary wall positivity was present for IgG1, IgG2, as well as IgG4, and negative for IgG3. While autoimmune diseases, including systemic lupus erythematous, have long been associated with MN, other vague autoimmune syndromes have also been reported, including inflammatory arthritis and ITP [ 14 – 16 ]. Additionally, an association between Helicobacter pylori infection and autoimmune diseases has been previously reported, including SLE, Sjogren's disease, and rheumatoid arthritis [ 17 ].…”

Tocilizumab Attenuates Anti-neutrophil Cytoplasmic Antibody-associated Nephritis Occurring during Abatacept and Adalimumab Therapy for Rheumatoid Arthritis

“…Vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA), called ANCA-associated vasculitis (AAV), accounts for 10% of renal complications in patients with rheumatoid arthritis (RA). The diagnosis rate of AAV has increased since 2000, when measurement of ANCA levels became possible and began to be performed clinically (1). AAV occurs in parallel with RA disease activity (1) and may develop during treatment for RA (2,3).…”