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Effective anti-tnf-î± therapy can induce rapid resolution and sustained decrease of gastroduodenal mucosal amyloid deposits in reactive amyloidosis associated with rheumatoid arthritis
Journal of Rheumatology, 10/09/09

Kuroda T et al. –This study examined the effect of anti-tumor necrosis factor-? (anti-TNF) therapy in patients with reactive AA amyloidosis associated with RA. 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

Methods

14 patients with reactive AA amyloidosis associated with RA were prospectively evaluated
Mean period of anti-TNF therapy 20.1 ± 13.8 mos
Laboratory findings and renal function examined before and after initiation of anti-TNF therapy
In 9 patients area of amyloid deposits in serial gastroduodenal mucosal biopsy specimens examined and image analysis performed

Results

C-reactive protein and serum amyloid A protein levels significantly reduced after initiation of anti-TNF therapy
24 hour creatinine clearance improved in 4 patients, did not change in 5, and deteriorated in 3
Biopsy specimens from 9 patients who underwent serial gastroduodenal biopsies showed significant decreases in area of amyloid deposits, from 8.8% ± 6.4% to 1.6% ± 0.6% (p = 0.003) after initiation of anti-TNF therapy
4 patients showed sustained decrease in areas of amyloid deposits in third biopsy specimens, and amyloid deposits not detectable in 2