Regression of the nephrotic syndrome in rheumatoid arthritis and amyloidosis treated with azathioprine

✍ Scribed by Deborah L. Shapiro; Harry Spiera

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 372 KB
• Volume: 38
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780381220

✦ Synopsis

Secondary or reactive (AA) amyloidosis is a well-known complication of certain rheumatic diseases, particularly rheumatoid arthritis (RA). This case report describes a patient with RA complicated by amyloidosis and the nephrotic syndrome, which regressed after treatment with azathioprine. The AA amyloidosis was documented by renal and lymph node biopsies and by the presence of proteinuria. Evaluation for other etiologies of proteinuria was negative. After treatment with azathioprine, the proteinuria resolved and the serum albumin level increased from 1.9 mg/dl to normal. This is the first published report of azathioprine therapy resulting in a reversal of the nephrotic syndrome in a patient with RA and secondary amyloidosis.

Secondary (AA) amyloidosis as a complication of rheumatoid arthritis (RA) is uncommon, but it remains an important problem. The incidence of amyloidosis in adult RA has been estimated at 5-15% in Europe (1,2). In juvenile rheumatoid arthritis (JRA), the incidence of amyloidosis has been estimated at 5-10% in Europe, and at <I% in the US (3,4). In AA amyloidosis, deposition of amyloid fibrils in the kidney occurs. Affected patients commonly present with proteinuria, later progressing to the nephrotic syndrome and renal failure. The prognosis for patients with amyloid nephropathy has been considered extremely poor, but there have been reports of improvement