Marked efficacy of adalimumab for secondary gastrointestinal amyloidosis accompanied with ankylosing spondylitis.
A 39-year-old man with seronegative rheumatoid arthritis which was refractory to methotrexate and prednisolone therapy complained of epigastralgia, melena and diarrhea. Diffuse mucosal damage was observed on endoscopic examination, and histological findings of the gastric and colonal mucosa showed AA type amyloidosis. He was diagnosed with ankylosing spondylitis (AS) on the basis of the clinical feature such as the limitation in range of motion of lumber spine, and sacroiliitis on MR imaging. Although digestive symptom ameliorated by fasting and antibiotic therapy, laboratory findings continued to reveal an elevation of serum C-reactive protein (CRP) value and arthritis worsened. However, after the initiation of the treatment with adalimumab (ADA), not only his manifestation but also serum levels of CRP became normalized promptly. As far as we could evaluated, follow-up colonoscopic examination showed normal mucosal findings and histologic examination proved that amyloid protein disappeared. Secondary gastrointestinal amyloidosis is ralely associated with AS. Therefore standard therapy is not established. This case might indicate an efficacy of ADA for secondary gastrointestinal amyloidosis accompanied with AS.
Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
Takeo
T
Abe
Naoto
N
Azuma
Tomoaki
T
Kono
Hiroyuki
H
Hao
Seiichi
S
Hirota
Chie
C
Ogita
Yuichi
Y
Yokoyama
Tetsuya
T
Furukawa
Takahiro
T
Yoshikawa
Takuya
T
Hino
Atsushi
A
Saito
Aki
A
Nishioka
Masahiro
M
Sekiguchi
Masayasu
M
Kitano
Schinichiro
S
Tsunoda
Kiyoshi
K
Matsui
Hajime
H
Sano
D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000686:Amyloidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D002097:C-Reactive Protein; D000068879:Adalimumab