Effective abatacept therapy in a hemodialysis patient with rheumatoid arthritis

Abstract

A 67-year-old female who had started receiving maintenance hemodialysis seven years ago presented with bilateral multiple arthralgia (of the fingers, wrist, glenohumeral joint, and knee joints) together with tenderness and joint swelling, which had lasted for four years. She was diagnosed with rheumatoid arthritis at another hospital based on her serological findings (her C-reactive protein and matrix metalloproteinase 3 levels) and imaging studies. Despite initial treatment with disease-modifying anti-rheumatic drugs, including salazosulfapyridine, leflunomide, and 12.5 mg/day of prednisolone, her disease activity remained constant. Etanercept, a biological agent that is often used to treat rheumatoid arthritis, was also ineffective. Thus, she was referred to our hospital three years ago, and abatacept treatment was started. Thereafter, her arthralgia and laboratory findings improved. There are few case reports about the use of biological agents to treat rheumatoid arthritis patients on hemodialysis, but the effective use of abatacept treatment in the present study suggests that abatacept is an alternative treatment for patients on hemodialysis with intractable rheumatoid arthritis.