Background Rheumatoid arthritis (RA) and Ankylosing Spondylitis (AS) are the most common inflammatory rheumatic diseases. Comparing to healthy population, chronic kidney disease (CKD) might be more common in these patients due to complications such as amyloidosis or toxicity because of drug use. Anti-TNF treatment is an effective option in treatments of RA and AS.There is limited data whether anti-TNF treatment is efficient and safe in patients with RA or AS. We summarized some early data of 9 patients in this poster which was the largest serie in the literature.
Objectives We analyzed our 9 CKD patients with RA or AS prospectively and aimed to evaluate efficacy and safety of anti-TNF treatment (infliksimab, etanercept, adalimumab, golimumab) in these patients.
Methods AS patient met the New York Modified Criteria and RA was diagnosed according to the classification criteria of the 2010 ACR/ EULAR. Patients who are creatinine level ≥1.3 mg/dL accepted as CKD. We measured sedimentation and CRP levels in all patients, BASDAI score in AS patients and DAS28 score in RA patients during follow-up period. Adverse effects such as infection and allergic reactions were noted.
Results We analyzed 3 RA and 6 AS patients with CKD due to amyloidosis (n=5), polycystic kidney disease (n=1), diabetic nephropathy (n=2), hypertension (n=1). Eight of patients were male and one patient was female. Two patients were under hemodialysis (Pateint 2, 5). Six patients received etanercept, one adalimumab, one golimumab and one infliksimab treatment. Six of patients took isoniazid prophylaxis. Only, Patient 1 was having leflunomid 20 mg/day and other synthetic DMARDs were not used in other patients. During follow up, DAS28 scores in RA patients and BASDAI scores in AS patients were decreased significantly and there were no increase in the scores. The efficacy data will publish in the future paper. The only adverse effect was a non-serious local allergic reaction was seen in patient 7. The detailed data was presented in Table 1.
Conclusions As a result, anti-TNF treatment appears to be safe, well-tolerated and efficient in chronic kidney patients with RA and AS in our limited number of patients. Nonetheless, increased infection risk in CKD patients must be kept in mind. Future studies in larger population groups about efficacy or safety of anti-TNF treatment in CKD patients is required.
Senel S, Kisacik B, Ugan Y, Kasifoglu T, Tunc E, Cobankara V. The efficacy and safety of etanercept in patients with rheumatoid arthritis and spondyloarthropathy on hemodialysis. Clin Rheumatol. 2011 Oct;30(10):1369-72.
Disclosure of Interest None declared
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