Marinchev Lyubomir, Atanasova Svetla, Robeva Raina, Todorov Todor
University Hospital, Rheumatology, 13 Urvitch, Sofia, 1612, Bulgaria.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0394. Epub 2009 Jun 18.
Rheumatoid arthritis (RA) is an inflammatory joint disease, in which, unlike systemic lupus erythematosus (SLE), renal involvement is uncommon. The major causes of renal disease in RA are usually linked to amyloid or secondary effects of drugs. Nevertheless the relation between IgA, IgA-rheumatoid factor (RF) and renal disease in patients with RA is not clear, but the affinity of IgA for mesangium, skin and synovium might explain clinical presentation of RA with mesangial IgA glomerulonephritis. The case of a 42-year-old Caucasian man with RA and diffuse mesangial IgA glomerulonephritis proven by renal biopsy is presented. The patient was treated with boluses of methylprednisolone 1000 mg and cyclophosphamide 1000 mg monthly for 13 months. Between boluses there was a supported therapy with methylprednisolone 8 mg/day. After a year of treatment full clinical and laboratory remission of RA and IgA glomerulonephritis was achieved. Pathogenic therapy will be stopped and the patient followed-up.
类风湿关节炎（RA）是一种炎症性关节疾病，与系统性红斑狼疮（SLE）不同，肾脏受累在RA中并不常见。RA患者肾脏疾病的主要原因通常与淀粉样变性或药物的继发效应有关。然而，RA患者中IgA、IgA类风湿因子（RF）与肾脏疾病之间的关系尚不清楚，但IgA对系膜、皮肤和滑膜的亲和力可能解释了RA合并系膜IgA肾小球肾炎的临床表现。本文报告了一例42岁白种男性RA患者，经肾活检证实为弥漫性系膜IgA肾小球肾炎。该患者接受了每月1000mg甲泼尼龙和1000mg环磷酰胺冲击治疗，共13个月。两次冲击治疗之间给予8mg/天甲泼尼龙维持治疗。经过一年的治疗，RA和IgA肾小球肾炎实现了完全临床和实验室缓解。将停止病原治疗并对患者进行随访。
