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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
- 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
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