Sección De Nefrología, Complejo Hospitalario La Mancha-Centro, Alcázar De San Juan, Ciudad Real, Spain.
Nefrologia. 2013;33(3):404-9. doi: 10.3265/Nefrologia.pre2012.Aug.11552. Epub 2012 Oct 23.
Rheumatological diseases and, firstly, rheumatoid arthritis (RA) remain a major cause of secondary amyloidosis. The emergence of biological agents such as adalimumab in the early treatment of RA can be an effective alternative to stop the development and progression of secondary amyloidosis. Not all patients will respond the same way to treatment; we must consider associated comorbidity, the poor prognosis factors for predicting therapeutic response and possible adverse effects. In the adverse effects of biological therapies, there has been an increase in the rate of lethal infections and congestive heart failure. We present two cases with renal amyloidosis secondary to RA who had a different clinical course: our 1st case had a good response to Adalimumab while the 2nd case evolved unfavourably after treatment, and died from cardiovascular complications.
风湿性疾病,尤其是类风湿关节炎(RA),仍然是继发性淀粉样变性的主要原因。阿达木单抗等生物制剂在 RA 的早期治疗中的出现,可以作为阻止继发性淀粉样变性发展和进展的有效替代方法。并非所有患者对治疗的反应都相同;我们必须考虑相关合并症、预测治疗反应的不良预后因素和可能的不良反应。在生物治疗的不良反应中,致死性感染和充血性心力衰竭的发生率有所增加。我们介绍了两例继发于 RA 的肾淀粉样变性病例,其临床过程不同:我们的第 1 例对阿达木单抗反应良好,而第 2 例在治疗后病情恶化,并死于心血管并发症。