Outcomes of thirty-four rheumatoid arthritis patients with renal amyloidosis, including twelve given alkylating agents.

We reviewed 34 cases of rheumatoid arthritis with biopsy-proven renal amyloidosis. Mean age was 57.1 +/- 13 years and mean duration of rheumatoid arthritis was 13.7 +/- 8.2 years. Renal function tests done at the time of diagnosis of amyloidosis were available for 32 patients and showed renal failure in 16. Twelve patients received an alkylating agent. Twenty patients (59%) died, after a mean interval of 25.7 +/- 25.1 months since the diagnosis of renal amyloidosis; 19 of these patients (95%) had renal failure. Seven of the 14 survivors and four of the 11 survivors with impaired renal function were given an alkylating agent; mean follow-up since the diagnosis of renal amyloidosis was 77.2 +/- 58.7 months. At completion of the study, renal function was normal in only three patients, all of whom received an alkylating agent. Our data confirms the bleak prognosis of renal amyloidosis in rheumatoid arthritis patients and suggests a need for randomized trials designed to evaluate the efficacy of alkylating agents in this condition.