Rheumatoid Arthritis Resistant to Conventional Treatment The Effect of Tumor Necrosis Factor Alpha Blocker Use on Renal Functions in Patients with Ankylosing Spondylitis

Abstract

Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) are chronic, inflammatory, systemic diseases. When these diseases are not controlled, they cause an increase in morbidity and mortality in patients. Although joint involvement is usually seen, other organs of the body can also be negatively affected by the inflammatory process. Tumor necrosis factor-α (TNF-α), a proinflammatory cytokine, has been implicated in the pathogenesis of RA and AS. Therefore, anti-TNF-α agents have been developed for therapeutic purposes. They have been shown to be especially effective in patients resistant to disease-modifying antirheumatic drugs (DMARDs). Among these, etanercept, infliximab and adalimumab have been approved by the US National Food and Drug Administration (FDA). There are not enough studies in the literature investigating the effects of these drugs on renal function. In this study, we aimed to investigate the effect of etanercept treatment on renal function in DMARD-resistant RA and AS patients. Between November 2005 and August 2006, 11 RA and 8 AS patients admitted to the outpatient clinic of the Department of Internal Medicine, Division of Rheumatology, Uludag University were included in the study. Patients were started on etanercept at a dose of 25 mg subcutaneously twice a week. Creatinine clearance, serum cystatin-c, serum β-2 microglobulin, N-acetyl β-D glucosaminidase (NAG) in 24-hour urine and microalbuminuria levels were investigated. At the end of treatment, statistically insignificant changes were observed in both serum and urinary parameters compared to pretreatment. In conclusion; in our study, we found that etanercept treatment had no positive or negative effect on glomerular and proximal tubule functions of the kidney in RA and AS patients receiving DMARD treatment.

Keywords

• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Etanercept
• N acetyl β-D glucoseaminidase
• Cystatin-c

Klasik Tedaviye Dirençli Romatoid Artrit ve Ankilozan Spondilit Hastalarında Tümör Nekroz Faktör Alfa Blokeri Kullanımının Böbrek Fonksiyonları Üzerine Etkisi

Abstract

Romatoid Artrit (RA) ve Ankilozan Spondilit (AS) kronik, inflamatuar, sistemik hastalıklardır. Bu hastalıklar kontrol altına alınmadığında hastalarda morbidite ve mortalitede artışa neden olmaktadır. Genellikle eklem tutulumu görülmesine rağmen inflamatuar süreçten vücudun diğer organları da olumsuz etkilenebilmektedir. RA ve AS’nin patogenezinde proinflamatuar sitokin olan tümör nekrozis faktör-α’nın (TNF-α) rolü olduğu anlaşılmiştır. Bu nedenle tedavi amaçlı anti- TNF-α ajanlar geliştirilmiştir. Özellikle de hastalığı modifiye edici antiromatizmal ilaçlara (DMARD) dirençli hastalarda etkin oldukları gösterilmiştir. . Biz bu çalışmamızda DMARD’a dirençli RA ve AS hastalarında etanersept tedavisinin böbrek fonksiyonları ve hasar markırları üzerine olan etkisini araştırmayı amaçladık. Çalışmaya Kasım 2005-Ağustos 2006 tarihleri arasında Uludağ Üniversitesi İç Hastalıkları Ana Bilim Dalı Romatoloji Bilim Dalı polikliniğine başvuran 11 RA ve 8 AS hastası alındı. Hastalara haftada iki kez subkutan 25 mg dozunda etanersept tedavisi başlandı. Tedavi öncesi, tedaviden sonra 4. hafta ve 16. haftalarda, kreatinin klirensi, serum sistatin-c, serum β-2 mikroglobulin, 24 saatlik idrarda N asetil β-D glukozaminidaz (NAG) ve mikroalbuminüri düzeyleri araştırıldı. Tedavi sonunda hem serum ve hem de idrarda bakılan parametrelerde tedavi öncesine göre istatiksel açıdan anlamlı olmayan değişiklikler gözlendi. Sonuç olarak; çalışmamızda, DMARD tedavisi alan RA ve AS hastalarında etanersept tedavisinin böbreğin glomerüler ve proksimal tübül fonksiyonları üzerine olumlu ya da olumsuz bir etkisinin olmadığını saptadık.

Keywords

• Romatoid Artrit
• Ankilozan Spondilit
• Etanersept
• N asetil β-D glukozaminidaz
• sistatin-c

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