Effective Anti-TNF-α Therapy Can Induce Rapid Resolution and Sustained Decrease of Gastroduodenal Mucosal Amyloid Deposits in Reactive Amyloidosis Associated with Rheumatoid Arthritis

Abstract

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.

Tocilizumab for the Treatment of AA Amyloidosis

“…As described elsewhere, etanercept treatment of patients with AA amyloidosis produced a decrease in SAA, but there were no significant changes in serum creatinine or proteinuria (Perry et al, 2008). In 2009, Kuroda et al reported the effect of TNF inhibitors on 14 patients with AA amyloidosis associated with RA (Kuroda et al, 2009). For the 4 patients treated with infliximab and 10 patients with etanercept, creatinine clearance improved in 4 patients, did not change in 5 patients, and deteriorated in 3 patients.…”

Marked and Rapid Regression of Hepatic Amyloid Deposition in a Patient with Systemic Light Chain (AL) Amyloidosis after High-dose Melphalan Therapy with Stem Cell Transplantation

“…However, it has been recently disclosed that dynamic turnover of constituent proteins does occur in these lesions and that amyloid deposits can regress if the supply of amyloid precursor is halted by treatment (22). In patients with familial amyloid polyneuropathy and AA amyloidosis, clear regression of tissue amyloid deposition after treatment is seen in the abdominal fat pad (23) or gastroduodenal mucosa (24,25), and similar findings have been reported in AL amyloidosis patients (8,9). With regard to hepatic amyloidosis, however, regression has only been demonstrated radiographically (26,27), not histopathologically, except for one case in which histological regression was observed 5.5 years after treatment (12).…”

Optimal Treatment Strategy for Amyloid A Amyloidosis in Rheumatic Diseases – Anti-Interleukin-6 Receptor Therapy

“…In Japan, the efficacy of anti-TNF therapy has been reported in many papers and reports given at academic society meetings. Kuroda et al (2009) and Nakamura et al (2010) reported efficacy in a large number of patients over a short time. Kuroda et al analyzed therapeutic results in 14 RA patients complicated with AA amyloidosis in whom RA treatment was effective (four were given infliximab and 10 were given etanercept; mean www.intechopen.com Optimal Treatment Strategy for Amyloid A Amyloidosis in Rheumatic Diseases -Anti-Interleukin-6 Receptor Therapy 159 observation period: 20.1 months).…”

“…In a 24-h proteinuria assay, three patients showed decreased proteinuria, six were unchanged, and three became worse, indicating that progression of renal disorders was prevented in about 70% of patients. In nine patients subjected to serial gastroduoedenal biopsies, the level of amyloid deposits in the tissue was reported to decrease significantly (Kuroda et al, 2009). Nakamura et al (2010) used etanercept to treat 14 Japanese patients who had the SAA1.3 allele and high susceptibility to AA amyloidosis (mean observation period: 19 months) and analyzed their renal function profiles.…”