DMARD控制良好的類風濕性關節炎合併類澱粉沉著症

Renal Amyloidosis in A Rheumatoid Arthritis Patient Well Controlled by Disease Modifying Anti-Rheumatic Drugs

類澱粉沉著症常出現在病史長且疾病活動程度高的類風濕性關節炎病患。本病例為一位50歲類風濕性關節炎病患接受44個月金製劑治療後發生腎病症候群，其疾病活動程度接受金製劑治療後控制良好且C反應蛋白在病程中皆在正常範圍內，然而腎臟切片呈現類澱粉沉著症而非藥物引起之膜性腎絲球腎炎。因此類澱粉沉著症可以出現在疾病活動程度低的類風濕性關節炎病患。而類澱粉沉著症與藥物引起之腎病變在臨床上難以區分，必須藉助病理學檢查才能得到正確的診斷。

Renal amyloidosis usually occurs in rheumatoid arthritis (RA) patients with a long history of active disease activity. A 50-year- old RA patient developed nephrotic syndrome caused by amyloidosis was here reported. This patient had received crysotherapy for 44 months and the disease activity of RA had been well controlled by this therapy. In addition, serum C-reactive protein value remained within normal limit throughout the whole course. Renal biopsy disclosed changes of amyloidosis rather than drug-induced membraneous glomerulonephritis. In conclusion, renal amyloidosis can develop in RA patients with inactive disease activity. An accurate pathological diagnosis is important in differentiating renal amyloidosis from drug-induced nephropathy.