Document Detail

Effective anti-TNF-alpha therapy can induce rapid resolution and sustained decrease of gastroduodenal mucosal amyloid deposits in reactive amyloidosis associated with rheumatoid arthritis.
MedLine Citation:
PMID:  19797512     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the effect of anti-tumor necrosis factor-alpha (anti-TNF) therapy in patients with reactive AA amyloidosis associated with rheumatoid arthritis (RA). METHODS: Fourteen patients with reactive AA amyloidosis associated with RA were prospectively evaluated. Four patients were treated with infliximab and 10 with etanercept. The mean period of anti-TNF therapy was 20.1 +/- 13.8 months. Laboratory findings and renal function were examined before and after initiation of anti-TNF therapy. In 9 patients the area of amyloid deposits in serial gastroduodenal mucosal biopsy specimens was examined and image analysis was performed. RESULTS: C-reactive protein and serum amyloid A protein levels were significantly reduced after initiation of anti-TNF therapy. Twenty-four hour creatinine clearance improved in 4 patients, did not change in 5, and deteriorated in 3. Twenty-four hour urinary protein excretion was significantly decreased in 3 patients, not exacerbated in 6, and increased in 3 after initiation of anti-TNF therapy. The biopsy specimens from the 9 patients who underwent serial gastroduodenal biopsies showed significant decreases in the area of amyloid deposits, from 8.8% +/- 6.4% to 1.6% +/- 0.6% (p = 0.003) after initiation of anti-TNF therapy. Four patients showed a sustained decrease in the areas of amyloid deposits in their third biopsy specimens, and amyloid deposits were not detectable in 2. CONCLUSION: Our results indicate a striking effect of anti-TNF therapy for rapid removal and sustained disappearance of amyloid deposits in gastric mucosal tissue with amelioration of renal functions in patients with reactive amyloidosis due to RA.
Takeshi Kuroda; Yoko Wada; Daisuke Kobayashi; Shuichi Murakami; Takehito Sakai; Shintaro Hirose; Naohito Tanabe; Takako Saeki; Masaaki Nakano; Ichiei Narita
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-01
Journal Detail:
Title:  The Journal of rheumatology     Volume:  36     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-06     Completed Date:  2010-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  2409-15     Citation Subset:  IM    
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Cyuo-ku, Niigata, Japan.
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MeSH Terms
Amyloid / immunology
Amyloidosis* / drug therapy,  pathology
Anti-Inflammatory Agents / therapeutic use
Antibodies, Monoclonal / therapeutic use
Arthritis, Rheumatoid* / drug therapy,  immunology,  pathology
Duodenum / anatomy & histology,  pathology
Gastric Mucosa / pathology*
Gastrointestinal Agents / therapeutic use
Immunoglobulin G / therapeutic use
Immunosuppressive Agents / therapeutic use*
Intestinal Mucosa / pathology*
Middle Aged
Receptors, Tumor Necrosis Factor / therapeutic use
Tumor Necrosis Factor-alpha / antagonists & inhibitors*,  immunology
Young Adult
Reg. No./Substance:
0/Amyloid; 0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/Gastrointestinal Agents; 0/Immunoglobulin G; 0/Immunosuppressive Agents; 0/Receptors, Tumor Necrosis Factor; 0/Tumor Necrosis Factor-alpha; 0/infliximab; 185243-69-0/TNFR-Fc fusion protein

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