2010
DOI: 10.2165/11586250-000000000-00000
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Secondary Amyloidosis in a Patient with Long Duration Crohnʼs Disease Treated with Infliximab

Abstract: Systemic AA amyloidosis is a serious complication of many chronic inflammatory disorders. Its association with Crohn's disease implies that the inflammatory burden is high enough for amyloid fibrils to form deposits in tissues. A case is presented in which this complication occurred while the patient was clinically well, with biological and endoscopic markers showing an inactive or mildly active disease under anti-tumor necrosis factor alpha therapy.

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Cited by 10 publications
(4 citation statements)
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“…There is no data for using other biologics like vedolizumab. Assessing amyloidosis response is difficult due to a lack of reliable biomarkers, in addition to symptomatic response, symptomatic remission, and normalization of CRP in many patients even with active AA amyloidosis, as was evidenced by many cases [23,32,33,[69][70][71]. What was unique in our case was that AA amyloidosis developed as proteinuria developed and renal eGFR declined even with normal FC results, raising the question of more successful methods of proactive monitoring, which is essential for ensuring that therapeutic strategies are effective and targets are met [72].…”
Section: Discussionmentioning
confidence: 99%
“…There is no data for using other biologics like vedolizumab. Assessing amyloidosis response is difficult due to a lack of reliable biomarkers, in addition to symptomatic response, symptomatic remission, and normalization of CRP in many patients even with active AA amyloidosis, as was evidenced by many cases [23,32,33,[69][70][71]. What was unique in our case was that AA amyloidosis developed as proteinuria developed and renal eGFR declined even with normal FC results, raising the question of more successful methods of proactive monitoring, which is essential for ensuring that therapeutic strategies are effective and targets are met [72].…”
Section: Discussionmentioning
confidence: 99%
“…Thus, CD activity must be regulated, tissue amyloid deposition should be avoided, and established deposits should be reduced. Tumor necrosis factor (TNF)-α inhibitors, particularly infliximab, have been consistently reported as an effective therapy for amyloidosis in CD [19][20][21][22] ; extrapolated evidence from rheumatic disease treatment supports the efficacy of TNFα inhibitors, but they are associated with an increased risk of infection. 23 Other strategies may be considered, including salicylates, methotrexate, and azathioprine; in addition, cyclosporine, mycophenolate, and thalidomide have been used.…”
Section: Discussionmentioning
confidence: 99%
“…Renal amyloidosis or drug toxicity was discussed to explain this situation. The renal biopsy was negative for amyloidosis and several case reports have described the efficacy of anti-TNF-α treatment on amyloid nephropathy complicating long-standing Crohn's disease, a treatment which induces a rapid response in proteinuria and a suppression of the renal disease activity [1][2][3][4][5][6].…”
Section: Discussionmentioning
confidence: 99%