ホシノ　ジユンイチ   Hoshino Jiyun'ichi   星野　純一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Abatacept Improves Intractable Protein-Losing Enteropathy Secondary to AA Amyloidosis in a Patient With Rheumatoid Arthritis
掲載誌名	正式名：Mayo Clinic proceedings. Innovations, quality & outcomes 略　 称：Mayo Clin Proc Innov Qual Outcomes ISSNコード：25424548/25424548
掲載区分	国外
巻・号・頁	4(6),pp.815-820
著者・共著者	Sawamura Masato, Sawa Naoki, Fujiwara Hideomi, Yamanouchi Masayuki, Hayami Noriko, Sekine Akinari, Mizuno Hiroki, Hasegawa Eiko, Suwabe Tatsuya, Hoshino Junichi, Kinowaki Keiichi, Fujii Takeshi, Ubara Yoshifumi
発行年月	2020/12
概要	A 71-year-old Japanese woman with a history of rheumatoid arthritis of 50 years' duration was admitted to our hospital with refractory diarrhea. Endoscopic biopsy revealed AA amyloid deposition in the large intestine. Although the patient had been prescribed 5 tumor necrosis factor inhibitors over the past 10 years, rheumatoid arthritis was poorly controlled, with a Disease Activity Score 28 using C-reactive protein score of 6.52 on admission. Treatment with tocilizumab (8 mg/kg every 2 weeks) was initiated, but this was ineffective. After 3 months, abatacept (cytotoxic T-lymphocyte-associated antigen 4 immunoglobulin) was initiated (750 mg/mo) and the patient's diarrhea began to improve. After 3 months of abatacept treatment, serum albumin, C-reactive protein, and serum amyloid A levels had all decreased to within normal ranges. After 3 years of abatacept treatment, a repeat biopsy of the large intestine revealed a marked improvement in amyloid deposition. Interleukin 6 is a key factor in AA amyloid formation, but this case suggests that T-cell activation increases the production of cytokines (including interleukin 6) via a mechanism involving cytotoxic T-lymphocyte-associated antigen 4, resulting in a second key factor of AA amyloid formation.
DOI	10.1016/j.mayocpiqo.2020.07.007
PMID	33367218