Reactive systemic AA amyloidosis is a severe complication of rheumatoid arthritis (RA), occurring in 2–5% of RA patients (1). Infliximab, a monoclonal antibody against tumor necrosis factor (TNF ), is successfully used in the treatment of RA (2). TNF plays a key role in inducing the synthesis of the hepatic acute-phase reactant protein serum amyloid A, the precursor of tissue AA amyloid. There have been reports of TNF blockade treatment in patients with rheumatic diseases complicated by renal AA amyloidosis (3,4). The major concern with infliximab is the possible increase of infections, and no established data have been presented on the safety of infliximab in patients with hepatitis B virus (HBV) infection. This report describes the case of a patient with RA, renal amyloidosis, and HBV-related chronic hepatitis in whom infliximab improved renal function with the disappearance of HBV replication.
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Anelli et al. (2005) studied this question.
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