The Korean Journal of Medicine

  • 제87권4호
  • /
  • Pages.514-519
  • /
  • 2014
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

종양괴사인자 억제제 불응 강직성 척추염 환자에서 발생한 아밀로이드증

Case of Secondary Amyloidosis in a Patient with Ankylosing Spondylitis Refractory to TNF-${\alpha}$ Inhibitors

  • 이민진 (부산대학교 의학전문대학원 내과학교실) ;
  • 이승근 (부산대학교 의학전문대학원 내과학교실) ;
  • 박은경 (부산대학교 의학전문대학원 내과학교실) ;
  • 장선미 (부산대학교 의학전문대학원 내과학교실) ;
  • 백성민 (부산대학교 의학전문대학원 내과학교실) ;
  • 송근암 (부산대학교 의학전문대학원 내과학교실) ;
  • 김근태 (고신대학교 의과대학 내과학교실)
  • Lee, Min-Jin (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Seung-Geun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Eun-Kyoung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Jang, Sun-Mi (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Baek, Sung-Min (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Song, Geun-Am (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Geun-Tae (Department of Internal Medicine, Kosin University College of Medicine)
  • 투고 : 2013.10.26
  • 심사 : 2014.03.07
  • 발행 : 2014.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

저자들은 강직성 척추염 환자에서 여러 종류의 종양괴사 인자 억제제를 장기간 투여하였음에도 불구하고 강직성 척추염에 의한 염증이 조절이 되지 않아 이차적으로 발생한 아밀로이드증을 경험하였기에 이를 문헌 고찰과 함께 보고 하는 바이다.

Secondary amyloidosis occurs in patients with chronic inflammatory diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The major therapeutic approach to secondary amyloidosis involves controlling the underlying inflammatory disease. Tumor necrosis factor-alpha (TNF-${\alpha}$) inhibitors have revolutionized the treatment of rheumatic diseases; in many cases dramatic clinical improvement of secondary amyloidosis due to AS has been observed in response to treatment with these agents. However, the development of secondary amyloidosis associated with AS refractory to treatment with TNF-${\alpha}$ inhibitors has been infrequently reported. Here, we described a case of a 37-year-old male patient with longstanding AS who was diagnosed with secondary amyloidosis due to high disease activity despite treatment with etanercept, adalimumab and infliximab.

키워드

참고문헌

  1. Singh G, Kumari N, Aggarwal A, Krishnani N, Misra R. Prevalence of subclinical amyloidosis in ankylosing spondylitis. J Rheumatol 2007;34:371-373.
  2. Gratacos J, Orellana C, Sanmarti R, et al. Secondary amyloidosis in ankylosing spondylitis: a systematic survey of 137 patients using abdominal fat aspiration. J Rheumatol 1997;24:912-915.
  3. Gottenberg JE, Merle-Vincent F, Bentaberry F, et al. Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy. Arthritis Rheum 2003;48:2019-2024. https://doi.org/10.1002/art.11163
  4. Fernandez-Nebro A, Tomero E, Ortiz-Santamaria V, et al. Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists. Am J Med 2005;118:552-556. https://doi.org/10.1016/j.amjmed.2005.01.028
  5. Kobak S, Oksel F, Kabasakal Y, Doganavsargil E. Ankylosing spondylitis-related secondary amyloidosis responded well to etanercept: a report of three patients. Clin Rheumatol 2007;26:2191-2194. https://doi.org/10.1007/s10067-007-0679-x
  6. Min HK, Yoon MH, Kim EO, et al. Secondary amyloidosis development in a patient with juvenile rheumatoid arthritis on TNF-alpha inhibitors treatment. J Rheum Dis 2012;19:280-284. https://doi.org/10.4078/jrd.2012.19.5.280
  7. Donmez S, Pamuk ON, Pamuk GE, Aydogdu E, Inman R. Secondary amyloidosis in ankylosing spondylitis. Rheumatol Int 2013;33:1725-1729. https://doi.org/10.1007/s00296-012-2646-3
  8. Cho SK, Kim TK, Her MY, Kim DY, Kang MS, Yoon JH. A case of amyloidosis with intestinal pseudo-obstruction in an ankylosing spondylitis patient. Korean J Med 2008;74:245-249.
  9. Gillmore JD, Lovat LB, Persey MR, Pepys MB, Hawkins PN. Amyloid load and clinical outcome in AA amyloidosis in relation to circulating concentration of serum amyloid A protein. Lancet 2001;358:24-29. https://doi.org/10.1016/S0140-6736(00)05252-1
  10. Roque R, Ramiro S, Cordeiro A, Gonçalves P, Da Canas S, Santos MJ. Development of amyloidosis in patients with rheumatoid arthritis under TNF-blocking agents. Clin Rheumatol 2011;30:869-870. https://doi.org/10.1007/s10067-011-1732-3

피인용 문헌

  1. TNF-α Inhibitor Treatment in an Ankylosing Spondylitis Patient with Secondary Amyloidosis that Manifest with Diarrhea: A Case Report vol.89, pp.2, 2014, https://doi.org/10.3904/kjm.2015.89.2.259