Treatment of AA amyloid with chlorambucil

V. Ortiz-Santamaría, A. Olivé, M. Valls-Roc and X. Tena

Rheumatology Section, Hospital Universitari Germans Trias i Pujol, CRTA Canyet sn, Badalona 08916, Spain

SIR, We read with interest the paper of Chevrel et al. [1] and would like to comment on it. Between 1984 and 1999 we diagnosed 23 patients with AA amyloid (eight males and 15 females). Three of them were lost to follow-up. The mean age of the remaining 20 patients was 56±23.6 yr (range 10–83 yr). Rheumatic diseases were the main cause of AA amyloid; 11 patients had rheumatoid arthritis (RA), five ankylosing spondylitis (AS), one juvenile rheumatoid arthritis (JRA), two vasculitis and one gout. Twelve of these patients were treated with chlorambucil (CHLO; 1 mg/kg/day); these patients comprised eight with RA, two with AS, one with JRA and one with vasculitis. The mean duration of treatment was 30±28.91 months (range 3–91 months), mean follow-up period 44.6±37.85 months (range 7–108 months). Data on creatinine concentration, creatinine clearance and proteinuria are shown in Table 1Go. Some of these data have been published elsewhere [24].


View this table:
[in this window]
[in a new window]
 
TABLE 1.  Creatinine concentration, creatinine clearance and proteinuria

 
Interestingly, there is a trend in our CHLO-treated patients to a decrease in proteinuria. However, renal function tends to get worse, which could also be seen in Chevrel's patients (although function did not get significantly worse). Another point of interest is that AS is well represented in our amyloid patients, whereas Chevrel's group of patients included only one with this disease. The difference might be explained by the type of centre and the referral area [1].

Treatment of amyloid is a matter of controversy. However, most authors prefer immunosuppressants, namely methotrexate [5], cyclophosphamide [1] and CHLO [6]. Normal renal function before the onset of treatment is the best prognostic indicator. Survival of amyloid patients is favoured by early diagnosis and aggressive treatment [6, 7].

Notes

Correspondence to: A. Olivé. Back

References

  1. Chevrel G, Jenvrin C, McGregor B, Miossec P. Renal type AA amyloidosis associated with rheumatoid arthritis: a cohort study showing improved survival on treatment with pulse cyclophosphamide. Rheumatology2001;40:821–5.[Abstract/Free Full Text]
  2. Gumá M, Bayes B, Bonet J, Olivé A. Gout and secondary amyloid. Clin Rheumatol1999;18:54–5.[ISI][Medline]
  3. Casado E, Holgado S, Teixidó J, Olivé A. Giant cell (temporal) arteritis and secondary amyloid: a matter of disease duration? J Rheumatol1998;25:822.
  4. Ortiz-Santamaria V, Gumá M, Olivé A, Tena X. Clorambucilo en el tratamiento de la amiloidosis secundaria. Med Clin2000;114:679.
  5. Fiter Areste J, Nolla Sole JM, GomezVaquero C, Valverde Gracia J, Roig Escofet D. Amiloidosis secundaria a la artritis reumatoide. Estudio clínico de una serie de 29 casos. Ann Med Intern (Madrid)1999;16:615–9.
  6. Berglung K, Thysell HJ, Keller C. Results, principles and pitfalls in the management of renal AA-amyloidosis: a 10–21 year follow up of 16 patients with rheumatic disease treated with alkylating cytostatics. Ann Rheum Dis1993;20:2051–7.
  7. Ansell BM. Chlorambucil therapy in juvenile chronic arthritis. J Rheumatol1999;26:765–6.[ISI][Medline]
Accepted 12 February 2002





This Article
Full Text (PDF)
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Disclaimer
Request Permissions
Google Scholar
Articles by Ortiz-Santamaría, V.
Articles by Tena, X.
PubMed
PubMed Citation
Articles by Ortiz-Santamaría, V.
Articles by Tena, X.
Related Collections
Rheumatoid Arthritis
Myositis and Muscle Disease