Department of Nephrology, Kremlin Bicêtre Hospital, 94275 Le Kremlin Bicetre, France.
Nephrol Dial Transplant. 2009 Nov;24(11):3540-2. doi: 10.1093/ndt/gfp314. Epub 2009 Jun 25.
The association between seronegative spondyloarthro- pathies and IgA nephropathy is well documented, mainly in cases of ankylosing spondylitis (AS). However, although these diseases have been associated, the physiopathological links between each other appear unclear. Anti-TNFalpha agents have transformed the outcome of axial forms of AS resistant to conventional anti-inflammatory therapies. Infliximab, a monoclonal anti-TNFalpha antibody, has greatly improved the evolution of AS although several adverse events have been described. On the other hand, infliximab has been demonstrated to reduce renal symptoms associated with chronic inflammatory rheumatological diseases, such as amyloid A (AA) amyloidosis, but few data are available on its efficacy in controlling IgA nephropathy associated with AS [1,2]. We report here a case of IgA nephropathy associated with AS that became symptomatic, whereas infliximab therapy efficiently controlled the rheumatological disease. This suggests that even though infliximab therapy effectively controls rheumatological manifestations, it may not be able to prevent IgA nephropathy associated with AS. Thus, this case report illustrates the complexity of the physiopathology of both diseases.
血清阴性脊柱关节病与 IgA 肾病的相关性已有充分的文献记载，主要见于强直性脊柱炎（AS）。然而，尽管这些疾病之间存在关联，但彼此之间的病理生理联系似乎并不清楚。抗 TNF-α 药物改变了传统抗炎治疗无效的中轴型 AS 的结局。英夫利昔单抗是一种抗 TNF-α 的单克隆抗体，尽管已描述了几种不良反应，但它大大改善了 AS 的病情进展。另一方面，英夫利昔单抗已被证明可减轻与慢性炎症性风湿性疾病相关的肾脏症状，如淀粉样变性（AA）淀粉样变性，但关于其在控制与 AS 相关的 IgA 肾病方面的疗效的数据很少[1,2]。我们在此报告一例与 AS 相关的 IgA 肾病，该患者出现症状，而英夫利昔单抗治疗有效地控制了风湿病。这表明，尽管英夫利昔单抗治疗能有效控制风湿病的表现，但它可能无法预防与 AS 相关的 IgA 肾病。因此，该病例报告说明了两种疾病的病理生理学的复杂性。
