Development of amyloidosis in patients with rheumatoid arthritis under TNF-blocking agents.

摘要

We have read with great interest the article by Nakamura et al. [1] describing the beneficial effect of etanercept in patients with renal amyloidosis secondary to rheumatoid arthritis (RA). Sustained chronic inflammation favors the occurrence of systemic amyloid A (AA) amyloidosis in RA patients [2] and the control of the inflammatory process is of crucial importance for amyloidosis prevention, as once this condition is established, its treatment is often disappointing. Some recent reports, including the one by Nakamura, have demonstrated a beneficial effect of anti-TNF [3, 4], anti-IL-6 [5], and B cell depletion [6] therapies in AA amyloidosis. These therapies could therefore represent a hope for patients with AA amyloidosis secondary to RA. Unfortunately, biologic agents do not prevent amyloidosis progression or even its development in all patients.