Cytotoxic drug treatment of reactive amyloidosis in rheumatoid arthritis with special reference to renal insufficiency.
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 repeated 51Cr-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 less than 0.04).
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000188:drug therapy* / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001379:Azathioprine / Q000627:therapeutic use; D002699:Chlorambucil / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011033:Podophyllin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011034:Podophyllotoxin / Q000031:analogs & derivatives; D011446:Prospective Studies; D011897:Random Allocation
D002699:Chlorambucil; C003170:mitopodozide; D003520:Cyclophosphamide; D011033:Podophyllin; D011034:Podophyllotoxin; D001379:Azathioprine