Rheumatology and Rheumatology Unit, University and AOU of Cagliari, Cagliari, Italy.
Rheumatology and Rheumatology Unit, University and AOU of Cagliari, Cagliari, Italy.
Autoimmun Rev. 2014 Aug;13(8):873-9. doi: 10.1016/j.autrev.2014.05.005. Epub 2014 May 16.
The use of biologic drugs has been linked with the paradoxical development of systemic and organ specific autoimmune processes. The aim of this study was to describe the features of biologics-induced autoimmune renal disorders (AIRD) through a systematic review and a cohort study of 707 adult patients affected with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (SA) and Psoriatic Arthritis (PsA). The literature search identified 2687 articles of which 21 were considered relevant for the present study, accounting for 26 case reports. The cohort analysis retrieved 3 cases. According to clinical manifestations and kidney histology the identified AIRD cases were classified as: a) glomerulonephritis associated with systemic vasculitis (GNSV), b) glomerulonephritis in lupus-like syndrome (GNLS), c) isolated autoimmune renal disorders (IARD). Twenty-two out of 29 cases with AIRD were reported in patients affected by RA, 5 in AS and 2 in PsA. The biologic drug most frequently associated with development of AIRD was Etanercept (15 cases, 51.7%), followed by Adalimumab (9 cases, 31.0%) and Infliximab (3 cases, 10.3%) while Tocilizumab and Abatacept were reported in 1 case (3.4%) for each. Thirteen out of 29 (44.8%) cases were classified as affected by IARD, 12 (41.3%) as GNSV and 4 (13.9%) as GNLS. Worse prognosis was associated with GNSV and lack of biologic withdrawal. Although rare, AIRD may be life-threatening and may lead to renal failure and death. If AIRD occurs, biologic drugs must be stopped and patient should be treated according to clinical manifestations and kidney biopsy findings.
生物制剂的使用与全身和器官特异性自身免疫过程的反常发展有关。本研究的目的是通过对 707 例成年类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病关节炎（PsA）患者的系统回顾和队列研究，描述生物制剂引起的自身免疫性肾疾病（AIRD）的特征。文献检索共识别出 2687 篇文章，其中 21 篇被认为与本研究相关，占 26 例病例报告。队列分析共检索到 3 例。根据临床表现和肾脏组织学，确定的 AIRD 病例分为：a）与系统性血管炎相关的肾小球肾炎（GNSV），b）狼疮样综合征相关的肾小球肾炎（GNLS），c）自身免疫性肾疾病（IARD）。29 例 AIRD 中，22 例报告发生在 RA 患者，5 例发生在 AS，2 例发生在 PsA。与 AIRD 发展最相关的生物制剂是依那西普（15 例，51.7%），其次是阿达木单抗（9 例，31.0%）和英夫利昔单抗（3 例，10.3%），而托珠单抗和阿巴西普各报告 1 例（3.4%）。29 例中的 13 例（44.8%）被归类为 IARD，12 例（41.3%）为 GNSV，4 例（13.9%）为 GNLS。GNSV 和未停用生物制剂与较差的预后相关。尽管罕见，但 AIRD 可能危及生命，并可能导致肾衰竭和死亡。如果发生 AIRD，必须停止使用生物制剂，并根据临床表现和肾活检结果进行治疗。
