ホシノ　ジユンイチ   HOSHINO Junichi   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	Use of biologic agents and methotrexate improves renal manifestation and outcome in patients with rheumatoid arthritis: a retrospective analysis.
掲載誌名	正式名：Clinical and experimental nephrology 略　 称：Clin Exp Nephrol ISSNコード：14377799/13421751
巻・号・頁	26(4),pp.341-349
著者・共著者	Sawamura Masato, Sawa Naoki, Yamanouchi Masayuki, Ikuma Daisuke, Sekine Akinari, Mizuno Hiroki, Kawada Masahiro, Hiramatsu Rikako, Hayami Noriko, Hasegawa Eiko, Suwabe Tatsuya, Hoshino Junichi, Kono Kei, Kinowaki Keiichi, Ohashi Kenichi, Yamaguchi Yutaka, Ubara Yoshifumi
発行年月	2022/04
概要	BACKGROUND AND PURPOSE:We examined whether advances in treatment strategies from older disease-modifying antirheumatic drugs (DMARDs) to new biologic agents and methotrexate improved renal complications and outcome in patients with rheumatoid arthritis (RA).METHODS:We reviewed records of 156 patients with RA who underwent kidney biopsy at our institute between January 1990 and December 2019. All patients were assigned to one of three periods: period 1, 1990-1999 (n = 48); period 2, 2000-2009(n = 57); period 3, 2010-2019 (n = 51).RESULTS:Membranous nephropathy, nephrosclerosis, AA-amyloidosis, and IgA nephropathy were the four major renal manifestations of RA. AA-amyloidosis was diagnosed by kidney biopsy in 21 patients: period 1, 7 patients (15%); period 2, 10 patients (18%); and period 3, 4 patients (8%). The 4 patients in period 3 were in the years 2010-2014, and no new case of AA-amyloidosis was recorded from 2015 to 2019. In all 21 of the patients with AA-amyloidosis, neither a biologic agent nor methotrexate was administered. Fifteen of the 21 patients required dialysis, and 13 died in periods 1-3 because of amyloid-related cardiac dysfunction less than 2 years after the initiation of dialysis. Two of them are doing well using biologic agent despite dialysis. The remaining three patients who received a biologic agent or methotrexate does not progress to end-stage renal failure. In addition, the other renal complications showing progression to dialysis also decreased over time.CONCLUSION:Advances in treatment strategies have improved renal outcome and reduced mortality in patients with RA.
DOI	10.1007/s10157-021-02160-2
PMID	34846624