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Cytotoxic drug treatment of reactive amyloidosis in rheumatoid arthritis with special reference to renal insufficiency

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Summary

Twenty-two patients with amyloidosis secondary to rheumatoid arthritis were randomised and followed prospectively in order to determine whether treatment with cytotoxic drugs could postpone the development of end-stage renal failure. The diagnosis of amyloidosis was based on albuminuria, amyloid-positive rectal and/or abdominal fat aspiration and/or renal biopsies. Renal function was followed by repeated51Cr-EDTA measurements of the glomerular filtration rate (GFR). Urinary albumin and serum-creatinine were found unreliable as predictors of renal function. GFR declined more rapidly in the patient group receiving only symptomatic drugs and no cytotoxic drugs (NT-group). After an initial decline, the GFR in the cytotoxic drug treatment group (T-group), mean treatment quotient 79%, levelled off and remained constant for a considerable time. The mean observation time was 45.7 months in the NT-group and 53.5 months in the T-group. Seven out of eleven patients in the NT-group developed end-stage renal disease, compared to two out of eleven patients in the T-group. The cumulative proportion of survivors in the NT-group at 36 and 60 months was 71% and 27% respectively. The corresponding figures in the T-group were 89% and 89%. The difference in favour of the cytotoxic drug-treated group was significant (p<0.04).

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Authors and Affiliations

  1. Department of Rheumatology, Sahlgrenska Sjukhuset, University of Gothenburg, S-413 45, Gothenburg, Sweden

    M. Ahlmen Doctor

  2. Department of Internal Medicine I, Sahlgrenska Sjukhuset, University of Gothenburg, S-413 45, Gothenburg, Sweden

    M. Ahlmen Doctor

  3. Department of Nephrology Section, Sahlgrenska Sjukhuset, University of Gothenburg, S-413 45, Gothenburg, Sweden

    J. Ahlmen & H. Bucht

  4. Department of Pathology, Sahlgrenska Sjukhuset, University of Gothenburg, S-413 45, Gothenburg, Sweden

    C. Svalander

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Ahlmen, M., Ahlmen, J., Svalander, C. et al. Cytotoxic drug treatment of reactive amyloidosis in rheumatoid arthritis with special reference to renal insufficiency. Clin Rheumatol 6, 27–38 (1987). https://doi.org/10.1007/BF02200997

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