Treatment with Biologic Agents Improves the Prognosis of Patients with Rheumatoid Arthritis and Amyloidosis

2012 ◽  
Vol 39 (7) ◽  
pp. 1348-1354 ◽  
Author(s):  
TAKESHI KURODA ◽  
NAOHITO TANABE ◽  
DAISUKE KOBAYASHI ◽  
HIROE SATO ◽  
YOKO WADA ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Biologic Therapy ◽  
Statistical Significance ◽  
Biologic Agents ◽  
Aa Amyloidosis ◽  
Free Survival ◽  
Risk Of Death ◽  
Amyloid A ◽  
Systemic Complication

Objective.Reactive amyloid A (AA) amyloidosis is a serious and life-threatening systemic complication of rheumatoid arthritis (RA). We evaluated the safety of therapy with anti-tumor necrosis factor and anti-interleukin 6 biologic agents in RA patients with reactive AA amyloidosis, together with prognosis and hemodialysis (HD)-free survival, in comparison with patients with AA amyloidosis without such therapy.Methods.One hundred thirty-three patients with an established diagnosis of reactive AA amyloidosis participated in the study. Clinical data were assessed from patient records at the time of amyloid detection and administration of biologics. Survival was calculated from the date when amyloid was first demonstrated histologically or the date when biologic therapy was started until the time of death or to the end of 2010 for surviving patients. Patients who had started HD were selected for inclusion only after the presence of amyloid was demonstrated.Results.Fifty-three patients were treated with biologic agents (biologic group) and 80 were not (nonbiologic group). Survival rate was significantly higher in the biologic group than in the nonbiologic group. Nine patients in the biologics group and 33 in the nonbiologic group started HD. Biologic therapy had a tendency for reduced risk of initiation of HD without any statistical significance.Conclusion.Patients with amyloidosis have a higher mortality rate, but the use of biologic agents can reduce risk of death. The use of biologics may not significantly influence the HD-free survival rate.

scholarly journals POS0514 IMPORTANCE OF BODY MASS MEASUREMENT AND THE GRIP STRENGTH TEST TO PREDICT FALLS IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 491.2-491
Author(s):  
M. Tada ◽  
Y. Yamada ◽  
K. Mandai ◽  
N. Hidaka
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Grip Strength ◽  
Muscle Mass ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Free Survival ◽  
Leg Muscle ◽  
And Function

Background:We previously reported that the prevalence of sarcopenia was 28% in patients with rheumatoid arthritis (RA) in a cohort study 1. RA patients have a high risk of falls and fractures 2. However, the predictors of falls and fractures in RA patients are not known.Objectives:Whether evaluation of muscle mass and function at baseline could predict falls and fractures during four-year follow-up was investigated.Methods:The four-year follow-up data from a prospective, observational study (CHIKARA study: Correlation researcH of sarcopenIa, sKeletal muscle and disease Activity in Rheumatoid Arthritis) were used. Muscle mass was measured by a body impedance analyzer, and leg muscle mass was calculated. The leg muscle score (max: 100, min: 0) reflected the ratio of leg muscle mass to overall weight. Grip strength as an indicator of muscle function was evaluated using a digital, hand-held, isokinetic dynamometer. The correlations between muscle mass or function and falls or fractures were analyzed by survival rates and Cox hazard ratios. Leg muscle mass and grip strength were investigated by receiver operating characteristic (ROC) curve analysis for correlations with falls or fractures.Results:A total of 100 RA patients (female: 78%, mean age: 66.1 years) were enrolled; 35 patients had falls, and 19 patients had fractures during the four-year follow-up. The leg muscle score, grip strength, age, and fractures at baseline were significantly correlated with falls. The cut-off values of the leg muscle score and grip strength were calculated to be 84.5 points (sensitivity: 0.79, specificity: 0.43) and 15.9 kg (sensitivity: 0.56, specificity: 0.70), respectively, by ROC curve analysis. The patients were divided into four groups by their leg muscle scores and grip strength; the numbers of falls and fractures are shown in Table 1 for each group. The fall-free survival rate was significantly lower in the group with low leg muscle score and low grip strength (35.3%) than in the other groups (P=0.002) (Figure 1). The hazard ratio for the both low group was significantly increased, 3.6-fold (95%CI: 1.1-11.5), compared to that in the both high group.Table 1.Numbers of falls and fractures by category of leg muscle score and grip strengthLG + GS+(n=34)LG - GS+(n=12)LG + GS-(n=37)LG - GS-(n=17)P value*Falls, N6515110.010Fractures, N34660.072LG+: leg muscle score >84.5 points, GS+: grip strength >15.9kg, LG-: leg muscle score ≤84.5 points, GS+: grip strength ≤15.9kg*: compared in four groups by Kruskal-Walls test.Figure 1.Fall-free survival rate in the four groupsConclusion:RA patients with both low leg muscle score and low grip strength at baseline were at high risk for falls during the four-year follow-up period. Evaluation of muscle mass and function can predict falls in RA patients.References:[1]Tada, M., Yamada, Y., Mandai, K. & Hidaka, N. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis21, 1962-1969, doi:10.1111/1756-185X.13335 (2018).[2]van Staa, T. P., Geusens, P., Bijlsma, J. W., Leufkens, H. G. & Cooper, C. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum54, 3104-3112, doi:10.1002/art.22117 (2006).Disclosure of Interests:None declared

scholarly journals Rituximab Therapy in Renal Amyloidosis Secondary to Rheumatoid Arthritis

Biomolecules ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 136 ◽  
Author(s):  
Levent Kilic ◽  
Abdulsamet Erden ◽  
Yusuf Sener ◽  
Berkan Armagan ◽  
Alper Sari ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Improvement ◽  
Inflammatory Diseases ◽  
Case Series ◽  
New Drugs ◽  
Renal Amyloidosis ◽  
Secondary Amyloidosis ◽  
Aa Amyloidosis ◽  
Amyloid A ◽  
Significant Clinical Improvement

Secondary amyloid A (AA) amyloidosis is a late and serious complication of poorly controlled, chronic inflammatory diseases. Rheumatoid arthritis (RA) patients with poorly controlled, longstanding disease and those with extra-articular manifestations are under risk for the development of AA amyloidosis. Although new drugs have proven to be significantly effective in the treatment of secondary AA amyloidosis, no treatment modality has proven to be ideal. To date, only in small case series preliminary clinical improvement have been shown with rituximab therapy for AA amyloidosis secondary to RA that is refractory to TNF-α inhibitors (TNF-i) therapy. In these case series, we assessed the efficacy and safety of rituximab therapy for patients with RA and secondary amyloidosis. Hacettepe University Biologic Registry was developed at 2005. The data of the RA patients who were prescribed a biological drug were recorded regularly. Patients with biopsy proven AA amyloidosis patients were screened. Of 1022 RA patients under biologic therapy, 0.7% patients had clinically apparent histologically confirmed amyloidosis. Four of seven patients who were prescribed rituximab at least one infusion enrolled to those case series. Two of four patients showed significant clinical improvement and one of them also had decrease in proteinuria and the other one had stable renal function and proteinuria. The main goal for the treatment of AA amyloidosis is to control the activity of the underlying disorder. In this study, we showed that rituximab may be an effective treatment in RA patients with amyloidosis who were unresponsive to conventional disease modifying anti-rheumatic drugs (DMARDs) and/or TNFi.

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

2009 ◽  
Vol 36 (11) ◽  
pp. 2409-2415 ◽  
Author(s):  
TAKESHI KURODA ◽  
YOKO WADA ◽  
DAISUKE KOBAYASHI ◽  
SHUICHI MURAKAMI ◽  
TAKEHITO SAKAI ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Aa Amyloidosis ◽  
Laboratory Findings ◽  
Protein Levels ◽  
Amyloid A ◽  
Biopsy Specimens ◽  
Amyloid Deposits ◽  
Reactive Amyloidosis ◽  
Serum Amyloid A Protein ◽  
Before And After

Objective.To examine the effect of anti-tumor necrosis factor-α (anti-TNF) therapy in patients with reactive AA amyloidosis associated with rheumatoid arthritis (RA).Methods.Fourteen patients with reactive AA amyloidosis associated with RA were prospectively evaluated. Four patients were treated with infliximab and 10 with etanercept. The mean period of anti-TNF therapy was 20.1 ± 13.8 months. Laboratory findings and renal function were examined before and after initiation of anti-TNF therapy. In 9 patients the area of amyloid deposits in serial gastroduodenal mucosal biopsy specimens was examined and image analysis was performed.Results.C-reactive protein and serum amyloid A protein levels were significantly reduced after initiation of anti-TNF therapy. Twenty-four hour creatinine clearance improved in 4 patients, did not change in 5, and deteriorated in 3. Twenty-four hour urinary protein excretion was significantly decreased in 3 patients, not exacerbated in 6, and increased in 3 after initiation of anti-TNF therapy. The biopsy specimens from the 9 patients who underwent serial gastroduodenal biopsies showed significant decreases in the area of amyloid deposits, from 8.8% ± 6.4% to 1.6% ± 0.6% (p = 0.003) after initiation of anti-TNF therapy. Four patients showed a sustained decrease in the areas of amyloid deposits in their third biopsy specimens, and amyloid deposits were not detectable in 2.Conclusion.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.

scholarly journals Clinical Course of Patients with Rheumatoid Arthritis Who Continue or Discontinue Biologic Therapy After Hospitalization for Infection: A Retrospective Observational Study

2021 ◽  
Author(s):  
Yusuke Kashiwado ◽  
Chikako Kiyohara ◽  
Yasutaka Kimoto ◽  
Shuji Nagano ◽  
Takuya Sawabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lower Risk ◽  
Biologic Therapy ◽  
Clinical Course ◽  
Biologic Agents ◽  
Oral Steroid ◽  
History Of ◽  
Independent Risk Factors ◽  
Oral Steroid Therapy ◽  
Clinical Records

Abstract Background: To analyse the subsequent clinical course of patients with rheumatoid arthritis (RA) who either continued or discontinued biologic agents after hospitalization for infections. Methods: We retrospectively reviewed the clinical records of 230 RA patients with 307 hospitalizations for infections under biologic therapy between September 2008 and May 2014 in 15 institutions for up to 18 months after discharge. The risks of RA flares and subsequent hospitalizations for infections from 61 days to 18 months after discharge were evaluated. Results: Survival analyses indicated that patients who continued biologic therapy had a significantly lower risk of RA flares (31.4% vs. 60.6%, P < 0.01), and a slightly lower risk of subsequent infections (28.7% vs. 34.5%, P = 0.37). Multivariate analysis showed that discontinuation of biologic therapy, diabetes, and a history of hospitalization for infection under biologic therapy were associated with RA flares. Oral steroid therapy equivalent to prednisolone 5 mg/day or more and chronic renal dysfunction were independent risk factors for subsequent hospitalizations for infections. Conclusions: Discontinuation of biologic therapy after hospitalization for infections may result in RA flares. Continuation of biologic therapy is preferable, particularly in patients without immunodeficiency.

scholarly journals Abdominal Fat Aspiration Biopsy and Genotyping of Serum Amyloid A Contribute to Early Diagnosis of Reactive AA Amyloidosis Secondary to Rheumatoid Arthritis

2003 ◽  
Vol 42 (9) ◽  
pp. 800-805 ◽  
Author(s):  
Watara ISHII ◽  
Masayuki MATSUDA ◽  
Akinori NAKAMURA ◽  
Naoshi NAKAMURA ◽  
Akio SUZUKI ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Diagnosis ◽  
Serum Amyloid A ◽  
Abdominal Fat ◽  
Serum Amyloid ◽  
Aspiration Biopsy ◽  
Aa Amyloidosis ◽  
Amyloid A

scholarly journals An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate

2021 ◽  
Vol 10 (21) ◽  
pp. 5083
Author(s):  
Sorin Barac ◽  
Roxana Ramona Onofrei ◽  
Petru Vlad Neagoe ◽  
Alexandra Ioana Popescu ◽  
Stelian Pantea ◽  
...  
Keyword(s):  
Survival Rate ◽  
Observational Study ◽  
Limb Salvage ◽  
Open Surgery ◽  
Limb Ischemia ◽  
Late Results ◽  
Acute Limb Ischemia ◽  
Free Survival ◽  
Risk Of Death ◽  
Revascularization Procedures

An observational study on 22 patients presenting with acute limb ischemia and SARS-CoV-2 infection, and without any other embolic risk factors, was performed. All patients were classified according to Rutherford classification for acute limb ischemia. The primary goal of this study was to assess the risk of amputation in these patients after revascularization procedures. The secondary goal was to find the correlation between acute limb ischemia (ALI) severity, patient comorbidities, risk of death, and the association of SARS-CoV-2 infection. The patients were treated by open surgery (18 patients—81.81%) or by the means of endovascular techniques (four patients—18.18%). The amputation-free survival rate was 81.81% in hospital and 86.36% at 1-month follow-up. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event. The application of the standard treatment—open surgery or endovascular revascularization—in patients with acute limb ischemia and SARS-CoV-2 infection represents the key to success for lower limb salvage.

scholarly journals Rheumatoid arthritis – a subject always in actuality

2015 ◽  
Vol 10 (2) ◽  
pp. 148-155
Author(s):  
Mihaela Daniela BALTA ◽  
◽  
Dumitru MATEI ◽  
Mihaela MILICESCU ◽  
Teodora ŞERBAN ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Urban Areas ◽  
Biologic Therapy ◽  
Statistical Significance ◽  
Positive Serology ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Das 28 ◽  
Average Education ◽  
The Impact

Aim. The main objective of this study is represented by a clinical and epidemiological evaluation of the impact that biologic therapy exerts on patients suffering from rheumatoid arthritis. Material and methods. We have performed a study on a lot made up of 92 patients with rheumatoid arthritis, treated and accounted for inside the Rheumatology Clinic of Cantacuzino Hospital Bucharest, where they underwent biologic therapy, and we have analyzed the epidemiological, clinical and paraclinical data, establishing correlations with the received therapy. Results. Results show that the lot was predominantly made up of patients from urban areas, with an average education level. Men have presented higher percentages of highly seropositive forms, whereas women had higher DAS 28 and increased ESR levels, as well as more frequently associated cardiovascular pathology, dyslipidemia and diabetes mellitus. A connection between the evolution of the disease and the number of births could not be confirmed. Smokers have recorded different responses to biologic therapy. Dyslipidemia was present in 69.6% of the patients, but cholesterol levels did not positively correlate with inflammation markers and were not influenced by treatment in order to establish a statistical significance, although patients treated with etanercept presented decreased levels of cholesterol. 89.1% of patients with dyslipidemia already had statins included in their therapy. The evolution of DAS 28 and ESR in the studied lot was in favor of patients treated with adalimumab and rituximab. Conclusions. An urban lifestyle, the level of education (an average level), gender, menopause, and smoking as well as intensely positive serology have all represented factors which determined the onset and evolution of rheumatoid arthritis. Smokers exhibited decreased responses to biologic therapy.

scholarly journals Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy

Medicine ◽  
2021 ◽  
Vol 100 (32) ◽  
pp. e26843
Author(s):  
Ju-Yang Jung ◽  
Young-Bae Kim ◽  
Ji-won Kim ◽  
Chang-Hee Suh ◽  
Hyoun-Ah Kim
Keyword(s):  
Rheumatoid Arthritis ◽  
Interleukin 6 ◽  
Biologic Therapy ◽  
Amyloid A

scholarly journals Olokizumab for treatment of rheumatoid arthritis

2021 ◽  
Vol 30 (2) ◽  
pp. 67-74
Author(s):  
S. Moiseev ◽  
P. Novikov ◽  
N. Chebotareva ◽  
S. Gulyaev ◽  
N. Bulanov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Monoclonal Antibody ◽  
Tumour Necrosis ◽  
Active Rheumatoid Arthritis ◽  
Biologic Agents ◽  
Aa Amyloidosis ◽  
Antirheumatic Drugs ◽  
Humanized Monoclonal Antibody ◽  
Favorable Safety ◽  
Necrosis Factor

Olokizumab is a new humanized monoclonal antibody targeting IL-6 that is approved for treatment of patients with moderately severe or severe active rheumatoid arthritis despite therapy with methotrexate and other conventional diseasemodifying antirheumatic drugs or biologic agents. The efficacy and favorable safety profile of olokizumab in combination with methotrexate in rheumatoid arthritis patients who had previously failed methotrexate or tumour necrosis factor inhibitors were established in the several international 3 phase clinical trials (CREDO). The authors present two cases of successful olokizumab administration and discuss the indications for its use in patients with rheumatoid arthritis to achieve clinical improvement and to prevent progression of AA-amyloidosis.

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