J Rheum Dis.  2013 Dec;20(6):389-392. 10.4078/jrd.2013.20.6.389.

Rheumatoid Arthritis with Secondary Amyloidosis and Chronic Kidney Disease with a Good Response to Etanercept

• Kim HW
• Noh JW
• Kim J

• KMID: 2223001
• DOI: http://doi.org/10.4078/jrd.2013.20.6.389

Abstract

Secondary amyloidosis is a severe complication of refractory rheumatoid arthritis for which no effective treatment exists. Although the benefits of tumor necrosis factor alpha inhibitors in rheumatoid arthritis treatment are well known, their role in renal amyloidosis secondary to rheumatoid arthritis is unclear and their safety in patients with chronic kidney disease is not well reported. We present an unusual case of a 65-year-old female with moderate renal failure and severe proteinuria, who was diagnosed with secondary amyloidosis associated with refractory rheumatoid arthritis subsequent to treatment with corticosteroids, methotrexate, hydroxychlorquine, and leflunomide. She was treated with etanercept 25 mg, administered as a subcutaneous injection twice weekly for 8 months. The patient had no complications following the treatment. Treatment with etanercept led to a decrease in proteinuria and stabilization of renal function over time.

Keyword

Amyloidosis; Chronic renal insufficiency; Etanercept; Rheumatoid arthritis

MeSH Terms

Adrenal Cortex Hormones
Aged
Amyloidosis*
Arthritis, Rheumatoid*
Female
Humans
Injections, Subcutaneous
Methotrexate
Proteinuria
Renal Insufficiency
Renal Insufficiency, Chronic*
Tumor Necrosis Factor-alpha
Etanercept
Adrenal Cortex Hormones
Methotrexate
Tumor Necrosis Factor-alpha

Figure

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  Figure 1. Light microscopic image (×400) demonstrating eosinophilic material deposits in mesangial matrix.

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  Figure 2. Congo red staining and the specific apple green birefringence in the glomerulus under polarized fluorescence microscope (×400).

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  Figure 3. Evolution of serum creatinine, urinary protein excretion and disease activity score 28 for rheumatoid arthritis before and after treatment with etanercept.

Reference

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