Komatsuda A, Morita K, Ohtani H, Yamaguchi A, Miura A B
Department of Internal Medicine, Akita University School of Medicine, Akita, Japan.
Am J Kidney Dis. 1998 Nov;32(5):E7. doi: 10.1016/s0272-6386(98)70154-4.
A 46-year-old woman developed nephrotic syndrome secondary to rheumatoid arthritis (RA). A renal biopsy showed deposition of amyloid fibrils in the subendothelial space of the glomerular capillary walls. After treatment with prednisolone (PSL, 40 mg/day), the levels of C-reactive protein (CRP) and serum amyloid A decreased to within normal limits for 2 weeks. However, the nephrotic syndrome persisted for 6 months after the therapy. To maintain the suppression of disease activity and to reduce PSL, methotrexate (5 mg/week) was added. The nephrotic syndrome resolved gradually, and the level of serum albumin returned to normal. Although renal prognosis of patients with nephrotic syndrome due to amyloidosis caused by RA has been considered poor, adequate and long-term treatment of RA with antiinflammatory drugs, including PSL and methotrexate, is useful for patients with secondary amyloidosis complicated by RA.
一名46岁女性继发于类风湿关节炎（RA）出现肾病综合征。肾活检显示肾小球毛细血管壁内皮下间隙有淀粉样纤维沉积。用泼尼松龙（PSL，40mg/天）治疗后，C反应蛋白（CRP）和血清淀粉样蛋白A水平降至正常范围并持续2周。然而，肾病综合征在治疗后持续了6个月。为维持疾病活动的抑制并减少PSL用量，加用了甲氨蝶呤（5mg/周）。肾病综合征逐渐缓解，血清白蛋白水平恢复正常。尽管由RA引起的淀粉样变性所致肾病综合征患者的肾脏预后一直被认为较差，但使用包括PSL和甲氨蝶呤在内的抗炎药物对RA进行充分且长期的治疗，对合并RA的继发性淀粉样变性患者是有用的。
