Secondary amyloidosis in Crohn’s disease: treatment with tumour necrosis factor inhibitor

• Published in: Gut 2006-02, Vol.55 (2), p.294-295
• Main Authors: Boscá, M M, Pérez-Baylach, C M, Solis, M A, Antón, R, Mayordomo, E, Pons, S, Mínguez, M, Benages, A
• Format: Article
• Language: English
• Subjects: Adult; amyloidosis; Amyloidosis - drug therapy; Antibodies, Monoclonal - therapeutic use; Biopsy; Crohn Disease - drug therapy; Crohn's disease; Gangrene; Humans; Inflammation; Infliximab; Letter; Male; Rodents; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; tumour necrosis factor inhibitor; Ultrasonic imaging
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2005.082057

The mucosa was macroscopically normal and biopsies were only slightly positive for Red Congo (there were a few irregularly distributed amyloid deposits) (fig 1) and positive on immunohistochemistry for substance P. 2 To date, there has been no effective treatment for secondary amyloidosis 3- 5 ; treatment consisted of treating the underlying inflammatory disease. 2, 6, 7 This case is interesting because, when treated with Infliximab, there was an important clinical and analytical improvement, apparently followed by a decrease in the degree of Red Congo stain for amyloid deposits. The clinical improvement in Crohn's perianal disease and the kidney abnormalities caused by amyloidosis (with an evident decrease in proteinuria values), as a response to the immunomodulating drugs, was remarkable, but even more so the fact that less amyloid deposits were seen in the second and third rectal biopsies. 8, 9 Further study is required to confirm the relationship between treatment and clinical improvement 10 and to determine if the combination of the three drugs is necessary (immunosupressor (azathioprine) + immunomodulator (Infliximab), and an anti-inflammatory drug (colchicine)), or if anti-TNF-α alone is effective.