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Excellent therapeutic effect of tocilizumab on intestinal amyloid a deposition secondary to active rheumatoid arthritis

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Abstract

A 64-year-old woman suffering from progressive amyloid A (AA) amyloidosis of the gastrointestinal (GI) tract, associated with active rheumatoid arthritis, was transferred to our hospital due to hypovolemic shock. Although intensive care, including treatment with prednisolone and methotrexate, improved the hypovolemic shock, paralytic ileus became dominant instead of the marked diarrhea, suggesting the terminal stage of AA amyloidosis of the GI tract. Thus, we administered tocilizumab, a humanized anti-interleukin 6 receptor antibody (8 mg/kg, repeated every 4 weeks). Two weeks after the first injection of tocilizumab, serum AA rapidly returned to their normal ranges in accordance with the amelioration of paralytic ileus and systemic joint pain. Surprisingly, after three courses of tocilizumab treatment, colon biopsy revealed no amyloid deposition. Tocilizumab is a promising agent to treat secondary AA amyloidosis by strongly suppressing serum AA levels.

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Authors and Affiliations

  1. Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan

    Daichi Inoue, Hiroshi Arima, Yoko Takiuchi, Seiji Nagano, Takaharu Kimura, Sonoko Shimoji, Minako Mori, Sumie Tabata, Soshi Yanagita, Akiko Matsushita, Kenichi Nagai & Takayuki Takahashi

  2. Department of Gastroenterology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan

    Chiharu Kawanami

  3. Department of Clinical Pathology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan

    Yukihiro Imai

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  1. Daichi Inoue
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  2. Hiroshi Arima
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  3. Chiharu Kawanami
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  4. Yoko Takiuchi
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  5. Seiji Nagano
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  6. Takaharu Kimura
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  7. Sonoko Shimoji
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  8. Minako Mori
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  9. Sumie Tabata
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  10. Soshi Yanagita
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  11. Akiko Matsushita
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  12. Kenichi Nagai
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  13. Yukihiro Imai
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  14. Takayuki Takahashi
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Corresponding author

Correspondence to Takayuki Takahashi.

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Inoue, D., Arima, H., Kawanami, C. et al. Excellent therapeutic effect of tocilizumab on intestinal amyloid a deposition secondary to active rheumatoid arthritis. Clin Rheumatol 29, 1195–1197 (2010). https://doi.org/10.1007/s10067-010-1422-6

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  • DOI: https://doi.org/10.1007/s10067-010-1422-6

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