PT  - JOURNAL ARTICLE
AU  - Takeshi Kuroda
AU  - Yoko Wada
AU  - Daisuke Kobayashi
AU  - Shuichi Murakami
AU  - Takehito Sakai
AU  - Shintaro Hirose
AU  - Naohito Tanabe
AU  - Takako Saeki
AU  - Masaaki Nakano
AU  - Ichiei Narita
TI  - Effective Anti-TNF-α Therapy Can Induce Rapid Resolution and Sustained Decrease of Gastroduodenal Mucosal Amyloid Deposits in Reactive Amyloidosis Associated with Rheumatoid Arthritis
AID  - 10.3899/jrheum.090101
DP  - 2009 Oct 01
TA  - The Journal of Rheumatology
PG  - jrheum.090101
4099  - http://www.jrheum.org/content/early/2009/09/30/jrheum.090101.short
4100  - http://www.jrheum.org/content/early/2009/09/30/jrheum.090101.full
AB  - Objective To examine the effect of anti-tumor necrosis factor-α (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.