Abstract
Introduction: Amyloid A (AA) amyloidosis is mainly a complication of connective tissue diseases including rheumatoid arthritis. AA amyloidosis resulting from the deposition of AA protein in various target organs, commonly in the kidney and gastrointestinal tract, may lead to multiple organ dysfunction. Tocilizumab (TCZ), an anti-interleukin (IL)-6 receptor antibody, is reportedly useful in the treatment of AA amyloidosis complicating rheumatic diseases by the suppression of serum AA levels and improvement of the clinical symptoms. We report a patient with rheumatoid arthritis (RA) complicated with reactive AA amyloidosis, who remarkably improved following the treatment with TCZ.
Case: An 80-year-old woman had suffered from RA for 5 years and was treated with methotrexate and other disease modifying anti-rheumatic drugs. She was admitted to the hospital because of anemia and extremity edema. She also experienced chronic diarrhea, continuous renal dysfunction, and bilateral knee arthritis. She was diagnosed with AA amyloidosis from a biopsy of the duodenum. TCZ was given as treatment for the RA considering past side effects of other drugs. After the second course of TCZ, joint symptoms and inflammation subsided including other clinical symptoms that gradually improved.
Conclusion: The present case showed the successful use of TCZ for the treatment of RA complicated by AA amyloidosis. Single use of TCZ is effective without combination therapy, and it has less severe side effects. It may be possible to use TCZ safely for elderly patients.
