Effects of Biologic Agents in Patients with Rheumatoid Arthritis and Amyloidosis Treated with Hemodialysis
| Autor: | Masaaki Nakano, Hiroe Sato, Daisuke Kobayashi, Ichiei Narita, Yoko Wada, Yukiko Nozawa, Takeshi Kuroda, Takeshi Nakatsue, Takako Saeki, Naohito Tanabe |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
rheumatoid arthritis
Adult Male medicine.medical_specialty medicine.medical_treatment Arthritis Kaplan-Meier Estimate reactive amyloidosis Gastroenterology Etanercept Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine AA amyloidosis Renal Dialysis Internal medicine Internal Medicine medicine Humans biologics 030212 general & internal medicine Aged Proportional Hazards Models 030203 arthritis & rheumatology Biological Products Serum Amyloid A Protein hemodialysis biology business.industry Proportional hazards model Amyloidosis C-reactive protein General Medicine Middle Aged medicine.disease Prognosis C-Reactive Protein Treatment Outcome Rheumatoid arthritis Antirheumatic Agents biology.protein Original Article Female Hemodialysis business medicine.drug |
| Zdroj: | Internal Medicine |
| ISSN: | 1349-7235 0918-2918 |
| Popis: | Objective Our objective was to examine the safety and effects of therapy with biologics on the prognosis of rheumatoid arthritis (RA) patients with reactive amyloid A (AA) amyloidosis on hemodialysis (HD). Methods Twenty-eight patients with an established diagnosis of reactive AA amyloidosis participated in the study. The survival was calculated from the date of HD initiation until the time of death, or up to end of June 2015 for the patients who were still alive. HD initiation was according to the program of HD initiation for systemic amyloidosis patients associated with RA. Results Ten patients had been treated with biologics before HD initiation for a mean of 28.2 months (biologic group), while 18 had not (non-biologic group). HD was initiated in patients with similar characteristics except for the tender joint count, swollen joint count, and disease activity score (DAS)28-C-reactive protein (CRP). History of biologics showed that etanercept was frequently used for 8 patients as the first biologic. There was no significant difference in the mortality rate according to a Kaplan-Meier analysis (p=0.939) and or associated risk of death in an age-adjusted Cox proportional hazards model (p=0.758) between both groups. Infections were significantly more frequent causes of death in the biologic group than in the non-biologic group (p=0.021). However, treatment with biologics improved the DAS28-CRP score (p=0.004). Conclusion Under the limited conditions of AA amyloidosis treated with HD, the use of biologics might affect infection and thus may not improve the prognosis. Strict infection control is necessary for the use of biologics with HD to improve the prognosis. |
| Databáze: | OpenAIRE |
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