Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Anti-tumor necrosis factor therapy→ Abstract #59
                                                                August 2003 → Newer Treatments → Anti-Tumor Necrosis Factor Therapy → Abstract #59

THE BENEFICIAL EFFECT OF INFLIXIMAB IN AMYLOIDOSIS SECONDARY TO JIA: A CASE WITH A 20 MONTH FOLLOW-UP

H. Ozdogan,¹ F. Gogus, S. Masatlioglu, D. Cevirgen

¹Rheumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey

The effect of Infliximab in the treatment of a case of systemic onset JIA complicated with AA amyloidosis is described. The patient is a 15-year old boy with a disease duration of 8 years. He was resistant to high dose MTX (1 mg/kg/wk) and required a mean of 0.3 mg/kg of prednisolon with frequent interventions of pulse steroid therapy. He was decided to start Infliximab (3 mg/kg) in April 2001, because of active systemic disease. Proteinuria was noted just after the second infusion. A rectal biopsy revealed AA amyloidosis. His initial proteinuria was 300 mg/24 hour which increased to 800 mg/d within a month. His infliximab dose was increased to 4 mg/kg. Because of an increase in the amount of proteinuria (1 gr/d), he was decided to recieve monthly infusions instead of two-monthly, after the 8. infusion. Only after the dissapearence of protein from the urine at the 13. infusion, the interval was increased to 6 weeks. By now he has recieved a total of 15 infusions. His creatinine and creatinine clearence are within normal limits. He has experienced no disease flares since the onset of Infliximab treatment. His initial ESR of 84 mm/h decreased to 20 mm/h, and CRP of 116 mg/l to 3 mg/l. There was a rise in his hematocrit levels from 27.4 to 31.8, and a fall in platelet count from 580.000 to 286.000/mm. There is no active joint since the 3. infusion. He experienced no side effect related to infliximab. Currently he is on prednisolon 2.5 mg/alternate day and MTX 7.5 mg/wk.
The 20 month follow-up of this patient shows us that it takes more than a year before the dissapearence of proteinuria, even in a patient where the onset of amyloidosis was recorded just after the initiation of Infliximab because of active disease. Monthly infusions seems to play a beneficial role in the control of disease activity as well as in the dissapearence of proteinuria.