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Karam S, Haidous M, Royal V, Leung N. Renal AA amyloidosis: presentation, diagnosis, and current therapeutic options: a review. Kidney Int 2023; 103:473-484. [PMID: 36502873 DOI: 10.1016/j.kint.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022]
Abstract
Amyloid A amyloidosis is thought to be the second most common form of systemic amyloidosis behind amyloidosis secondary to monoclonal Ig. It is the result of deposition of insoluble fibrils in the extracellular space of tissues and organs derived from the precursor protein serum amyloid A, an acute phase reactant synthesized excessively in the setting of chronic inflammation. The kidney is the most frequent organ involved. Most patients present with proteinuria and kidney failure. The diagnosis is made through tissue biopsy with involvement of the glomeruli in most cases, but also often of the vessels and the tubulointerstitial compartment. The treatment usually targets the underlying etiology and consists increasingly of blocking the inflammatory cascade of cytokines with interleukin-1 inhibitors, interleukin-6 inhibitors, and tumor necrosis factor-α inhibitors to reduce serum amyloid A protein formation. This strategy has also shown efficacy in cases where an underlying etiology cannot be readily identified and has significantly improved the prognosis of this entity. In addition, there has been increased interest at developing effective therapies able to clear amyloid deposits from tissues, albeit with mitigated results so far.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Mohamad Haidous
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Virginie Royal
- Division of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA; Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Kawahito Y, Morinobu A, Kaneko Y, Kohno M, Hirata S, Kishimoto M, Seto Y, Sugihara T, Tanaka E, Ito H, Kojima T, Matsushita I, Nishida K, Mori M, Murashima A, Yamanaka H, Nakayama T, Kojima M, Harigai M. Drug treatment algorithm and recommendations from the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication. Mod Rheumatol 2023; 33:21-35. [PMID: 35297492 DOI: 10.1093/mr/roac017] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA; JCR CPG for RA) according to recent changes in the medical environment in Japan. This article is a digest version of the guidance. METHODS We used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. A consensus was formed by CPG panel members. RESULTS We identified 36 important clinical questions regarding drug treatment and developed corresponding recommendations for RA. The recommendations included the following RA medications: non-steroidal anti-inflammatory drugs, corticosteroids, conventional synthetic disease-modifying antirheumatic drugs, biological disease-modifying antirheumatic drugs, anti-receptor activator for nuclear factor-κB ligand antibodies, and Janus kinase inhibitors, as well as the tapering and discontinuation of these medications. Recommendations regarding the efficacy and safety of treatments in the elderly and patients with comorbidities were also developed. Finally, we used these recommendations to create an original algorithm for drug treatment for RA based on the Treat-to-Target approach. CONCLUSION The 2020 JCR CPG for RA provides a useful tool for rheumatologists, health care professionals, and patients with RA, enabling shared decision-making in a variety of clinical situations.
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Affiliation(s)
- Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuko Kaneko
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiichi Tanaka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Masaaki Mori
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masayoshi Harigai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Nishimura A, Tateiwa M, Tajima S, Tada T. Efficacy of peficitinib in two patients with rheumatoid arthritis on maintenance hemodialysis. J Rural Med 2022; 17:193-195. [PMID: 35847752 PMCID: PMC9263949 DOI: 10.2185/jrm.2022-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: Treatment options for patients with rheumatoid arthritis on
maintenance hemodialysis with an inadequate response to biologic agents have not been
reported. In this report, we describe two patients who achieved remission after treatment
with peficitinib. Methods: Two 69- and 85-year-old patients with rheumatoid arthritis on
maintenance hemodialysis were previously treated with biologics and started on peficitinib
100 mg/day after the secondary failure of biologics. Discussion: In the two cases presented here, rheumatoid arthritis was almost
in remission and there were no adverse events, although the patients were switched to
peficitinib after secondary failure of the biologic agents. Among Janus kinase inhibitors,
peficitinib has the lowest renal excretion; therefore, its administration in patients on
dialysis is not contraindicated according to the package insert in Japan. The use of
biologic agents in patients on hemodialysis has been reported to be associated with a high
incidence of infections; therefore, care should be taken to avoid infections when
administering Janus kinase inhibitors. Conclusion: Janus kinase inhibitors with low renal excretion, such as
peficitinib, may be effective in patients with rheumatoid arthritis on maintenance
hemodialysis who have an inadequate response to biologic agents.
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Affiliation(s)
- Akito Nishimura
- Depratment of Orthopedics, Shimizu Welfare Hospital, 578-1 Ihara-cho, Shimizu-ku, Shizuoka City, Shizuoka 424-0114, Japan
| | - Masayuki Tateiwa
- Depratment of Orthopedics, Shimizu Welfare Hospital, 578-1 Ihara-cho, Shimizu-ku, Shizuoka City, Shizuoka 424-0114, Japan
| | - Shuuitirou Tajima
- Depratment of Orthopedics, Shimizu Welfare Hospital, 578-1 Ihara-cho, Shimizu-ku, Shizuoka City, Shizuoka 424-0114, Japan
| | - Takuya Tada
- Depratment of Orthopedics, Shimizu Welfare Hospital, 578-1 Ihara-cho, Shimizu-ku, Shizuoka City, Shizuoka 424-0114, Japan
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Babino G, Esposito M, Bianchi L, Giunta A. Long-term treatment with etanercept monotherapy in a hemodialyzed patient with moderate-to-severe plaque-type psoriasis and psoriatic arthritis. GIORN ITAL DERMAT V 2017; 153:882-884. [PMID: 29144096 DOI: 10.23736/s0392-0488.17.05586-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Graziella Babino
- Department of Dermatology, Tor Vergata University, Rome, Italy -
| | - Maria Esposito
- Department of Dermatology, Tor Vergata University, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, Tor Vergata University, Rome, Italy
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