Clinical Rheumatology

, Volume 29, Issue 12, pp 1395–1401

Etanercept can induce resolution of renal deterioration in patients with amyloid A amyloidosis secondary to rheumatoid arthritis

  • Tadashi Nakamura
  • Syu-ichi Higashi
  • Kunihiko Tomoda
  • Michishi Tsukano
  • Masahiro Shono
Original Article

DOI: 10.1007/s10067-010-1469-4

Cite this article as:
Nakamura, T., Higashi, S., Tomoda, K. et al. Clin Rheumatol (2010) 29: 1395. doi:10.1007/s10067-010-1469-4

Abstract

The benefit of biological therapies in rheumatoid arthritis (RA) treatment is well known, but their role in amyloid A (AA) amyloidosis secondary to RA is unclear. The aim of this study was to clarify the clinical benefit of etanercept in RA patients with AA amyloidosis. We treated 14 RA patients who had serum amyloid A protein (SAA) 1.3 allele, with biopsy-confirmed AA amyloidosis with etanercept and investigated the efficacy of etanercept treatment, focusing on renal function retrospectively. The AA amyloidosis improved and stabilized after 89.1 ± 27.2 weeks. Proteinuria decreased from 2.24 ± 0.81 to 0.57 ± 0.41 g/day (P < 0.01) and SAA fell from 250 ± 129 to 26 ± 15μg/ml (P < 0.01), respectively. Diarrhea secondary to gastrointestinal AA amyloidosis was less. Overall, the serum creatinine levels did not benefit with treatment, but in those with a creatinine values <2.0 mg/dl the creatinine level continued to fall (P = 0.021). Serum albumin increased following 96 weeks of etanercept treatment (P = 0.003). Etanercept treatment led to clinical improvement in proteinuria and serum albumin levels accompanied by a fall in SAA levels.

Keywords

AA amyloidosis Etanercept Renal function Renoprotective potential Rheumatoid arthritis SAA1.3 allele 

Abbreviations

RA

Rheumatoid arthritis

AA

Amyloid A

SAA

Serum amyloid A protein

TNF-α

Tumor necrosis factor alpha

CRP

C-reactive protein

ESR

Erythrocyte sedimentation rate

RF

Rheumatoid factor

DMARDs

Disease-modifying anti-rheumatic drugs

NSAIDs

Non-steroidal anti-inflammatory drugs

ACEIs

Angiotensin-converting enzyme inhibitors

mHAQ

Modified Health Assessment Questionnaire

DAS28

Disease activity score

MTX

Methotrexate

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Tadashi Nakamura
    • 1
  • Syu-ichi Higashi
    • 1
  • Kunihiko Tomoda
    • 2
  • Michishi Tsukano
    • 2
  • Masahiro Shono
    • 3
  1. 1.Section of Medicine and RheumatologyKumamoto Center for Arthritis and RheumatologyKumamotoJapan
  2. 2.Section of Orthopaedics and RheumatologyKumamoto Center for Arthritis and RheumatologyKumamotoJapan
  3. 3.Yuge HospitalKumamotoJapan

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