Skip to main content

Advertisement

SpringerLink
Log in

A case of AA amyloidosis associated with rheumatoid arthritis effectively treated with Infliximab

  • Case Report
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

We report the case of a 55-year-old Japanese woman with reactive AA amyloidosis associated with rheumatoid arthritis, in which inflammatory disease was completely suppressed with infliximab. Nephrotic syndrome was observed and renal biopsy specimens revealed amyloidosis deposits. Treatment with infliximab normalized the serum amyloid A (SAA) protein level, and subsequently nephritic syndrome disappeared and her creatinine clearance improved. Serial gastrointestinal biopsy specimens showed marked lasting regression of amyloid deposits. Thus treatment with infliximab represents an important therapeutic strategy for AA amyloidosis associated with RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Glenner GG (1980) Amyloid deposits and amyloidosis: the beta-fibrilloses (second of two parts). N Engl J Med 302:1283–1292

    PubMed  CAS  Google Scholar 

  2. Suzuki A, Ohoshone Y, Obana M, Mita S, Matsuoka Y, Irimajiri S, Fukuda J (1994) Cause of death in 81 autopsied patients with rheumatoid arthritis. J Rheumatol 21:33–36

    PubMed  CAS  Google Scholar 

  3. Rocken C, Shakespeare A (2002) Pathology, diagnosis and pathogenesis of AA amyloidosis. Virchows Arch 440:111–122

    Article  PubMed  Google Scholar 

  4. Kobayashi H, Tada S, Fuchigami T, Okuda Y, Takasugi K, Matsumoto T, Iida M, Aovagi K, Iwashita A, Daimaru Y, Fujishima M (1996) Secondary amyloidosis in patients with rheumatoid arthritis: diagnostic and prognostic value of gastroduodenal biopsy. Br J Rheumatol 35:44–49

    Article  PubMed  CAS  Google Scholar 

  5. Kuroda T, Tanabe N, Harada T, Murakami S, Hasegawa H, Sakatsume M, Nakano M, Gejyo F (2006) Long term mortality outcome in patients with reactive amyloidosis associated with rheumatoid arthritis. Clin Rheumatol 25:498–505

    Article  PubMed  Google Scholar 

  6. Kuroda T, Tanabe N, Sato H, Ajiro J, Wada Y, Murakami S, Hasegawa H, Sakatsume M, Nakano M, Gejyo F (2006) Outcome of patients with reactive amyloidosis associated with rheumatoid arthritis in dialysis treatment. Rheum Int 26:1147–1153

    Article  Google Scholar 

  7. Gillmore JD, Lovat LB, Persey MR, Pepys MB, Hawkins PN (2001) Amyloid load and clinical outcome in AA amyloidosis in relation to circulating concentration of serum amyloid A protein. Lancet 358:24–29

    Article  PubMed  CAS  Google Scholar 

  8. Ahlmen M, Ahlmen J, Svalander C, Bucht H (1987) Cytotoxic drug treatment of reactive amyloidosis in rheumatoid arthritis with special reference to renal insufficiency. Clin Rheumatol 6:27–38

    Article  PubMed  CAS  Google Scholar 

  9. Gottenberg JE, Merle-Vincent F, Bentaberry F, Allanore Y, Berenbaum F, Fautrel B, Combe B, Durbach A, Sibilia J, Dougados M, Mariette X (2003) Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy. Arthritis Rheum 48:2019–2024

    Article  PubMed  CAS  Google Scholar 

  10. Elkayam O, Hawkins PN, Lachmann H, Yaron M, Caspi D (2002) Rapid and complete resolution of proteinuria due to renal amyloidosis in a patient with rheumatoid arthritis treated with infliximab. Arthritis Rheum 46:2571–2573

    Article  PubMed  Google Scholar 

  11. Husby G (1985) Amyloidosis and rheumatoid arthritis. Clin Exp Rheumatol 3:173–180

    PubMed  CAS  Google Scholar 

  12. Kuroda T, Tanabe N, Sakatsume M, Nozawa S, Mitsuka T, Ishikawa H, Tohyama CT, Nakazono K, Murasawa A, Nakano M, Gejyo F (2002) Comparison of gastroduodenal, renal and abdominal fat biopsies for diagnosing amyloidosis in rheumatoid arthritis. Clin Rheumatol 21:123–128

    Article  PubMed  CAS  Google Scholar 

  13. Nakano M, Ueno M, Nishi S, Shimada H, Hasegawa H, Watanabe T, Kuroda T, Sato T, Maruyama Y, Arakawa M (1998) Analysis of renal pathology and drug history in 158 Japanese patients with rheumatoid arthritis. Clin Nephrol 50:154–160

    PubMed  CAS  Google Scholar 

  14. Smith GR, Tymms KE, Falk M (2004) Etanercept treatment of renal amyloidosis complicating rheumatoid arthritis. Intern Med J 34:570–572

    Article  PubMed  CAS  Google Scholar 

  15. Urieli-Shoval S, Linke RP, Matzner Y (2000) Expression and function of serum amyloid A, a major acute-phase protein, in normal and disease states. Curr Opin Hematol 7:64–69

    Article  PubMed  CAS  Google Scholar 

  16. Niewold TA, Gruys E, Kisilevsky R, Shirahama TS (1991) Fibril amyloid enhancing factor (FAEF)-accelerated amyloidosis in the hamster is not dependent on serine esterase activity and mononuclear phagocytosis. Scand J Immunol 34:101–107

    Article  PubMed  CAS  Google Scholar 

  17. Tanaka N, Yonekura H, Yamagishi S, Fujimori H, Yamamoto Y, Yamamoto H (2000) The receptor for advanced glycation end products is induced by the glycation products themselves and tumor necrosis factor-alpha through nuclear factor-kappa B, and by 17beta-estradiol through Sp-1 in human vascular endothelial cells. J Biol Chem 275:25781–25790

    Article  PubMed  CAS  Google Scholar 

  18. Yan SD, Zhu H, Zhu A, Golabek A, Du H, Roher A, Yu J, Soto C, Schmidt AM, Stern D, Kindy M (2000) Receptor-dependent cell stress and amyloid accumulation in systemic amyloidosis. Nat Med 6:643–651

    Article  PubMed  CAS  Google Scholar 

  19. Kluth DC, Rees AJ (1999) New approach to modify glomerular inflammation. J Nephrol 12:66–75

    PubMed  CAS  Google Scholar 

  20. Suranyi MG, Guasch A, Hall BM, Myers BD (1993) Elevated levels of tumor necrosis factor-alpha in the nephrotic syndrome in humans. Am J Kidney Dis 21:251–259

    PubMed  CAS  Google Scholar 

  21. McCarthy ET, Sharma R, Sharma M, Li JZ, Ge XL, Dileepan KN, Savin VJ (1998) TNF-alpha increases albumin permeability of isolated rat glomeruli through the generation of superoxide. J Am Soc Nephrol 9:433–438

    PubMed  CAS  Google Scholar 

  22. Okuda Y, Takasugi K (2006) Successful use of a humanized anti-interleukin-6 receptor antibody, tocilizumab, to treat amyloid A amyloidosis complicating juvenile idiopathic arthritis. Arthritis Rheum 54:2997–3000

    Article  PubMed  CAS  Google Scholar 

  23. Verschueren P, Lensen F, Lerut E, Claes K, De Vos R, Van Damme B, Westhovens R (2003) Benefit of anti-TNFalpha treatment for nephrotic syndrome in a patient with juvenile inflammatory bowel disease associated spondyloarthropathy complicated with amyloidosis and glomerulonephritis. Ann Rheum Dis 62:368–369

    Article  PubMed  CAS  Google Scholar 

  24. Stokes MB, Foster K, Markowitz GS, Ebrahimi F, Hines W, Kaufman D, Moore B, Wolde D, D’Agati VD (2005) Development of glomerulonephritis during anti-TNF-alpha therapy for rheumatoid arthritis. Nephrol Dial Transplant 20:1400–1406

    Article  PubMed  CAS  Google Scholar 

  25. Chin G, Luxton G, Harvey JM (2005) Infliximab and nephrotic syndrome. Nephrol Dial Transplant 20:2824–2826

    Article  PubMed  CAS  Google Scholar 

  26. Shakoor N, Michalska M, Harris CA, Block JA (2002) Drug-induced systemic lupus erythematosus associated with etanercept therapy. Lancet 359:579–580

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by a grant from the Intractable Disease Division, the Ministry of Health and Welfare, a Research Committee for Epochal Diagnosis and Treatment for Amyloidosis in Japan.

Author information

Authors and Affiliations

  1. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata City, 951-8510, Japan

    Takeshi Kuroda, Yasuhiro Otaki, Hiroe Sato, Takeo Fujimura, Takeshi Nakatsue, Syuichi Murakami, Minoru Sakatsume & Fumitake Gejyo

  2. Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Niigata City, 951-8518, Japan

    Masaaki Nakano

Authors
  1. Takeshi Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuhiro Otaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroe Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeo Fujimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takeshi Nakatsue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Syuichi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Minoru Sakatsume
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masaaki Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fumitake Gejyo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeshi Kuroda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuroda, T., Otaki, Y., Sato, H. et al. A case of AA amyloidosis associated with rheumatoid arthritis effectively treated with Infliximab. Rheumatol Int 28, 1155–1159 (2008). https://doi.org/10.1007/s00296-008-0590-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-008-0590-z

Keywords

Search

Navigation