－S 340 －
― F-435 ―
Thrombotic thrombocytopenic purpura(TTP) induced by trimethoprim-sulfamethoxazole in a rheumatoid arthritis : Case report
전북대학교병원
*손지연
1, 류완희
2, 홍윤경
3, 전병준
4Thromobotic thrombocytopenic purpura(TTP) is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report the first case of a patient with rheumatoid arthritis who developed TTP that was associated with Trimethoprim-sulfamethoxazole in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange(TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in rheumatoid arthritis & in using Trimethoprim-sulfamethoxazole is important for early diagnosis and treatment.
― F-436 ―
Etanercept in rheumotoid arthritis patients with chronic kidney disease
Department of Rheumatology, the Hospital for Rheumatic Disease, Hanyang University
*Soo kyung Cho, Yoon-kyoung Sung, Sang-Cheol Bae
Background: RA patients with renal failure are intolerant to most disease-modifying anti-rheumatic diseases (DMARDs) and NSAIDs due to their potential toxicity. In recent years, the development and use of the tumor necrosis factor (TNF) antagonists is a major breakthrough in the treatment of RA. However, their safety and efficacy in RA patients who have chronic kidney disease have not been well reported. Purpose:
To describe the safety and efficacy of etanercept treatment in RA patients with chronic kidney disease. Method : Three rheumotoid arthritis patients with chronic kidney disease who had been treated with DMARDS, steroids and NSAIDS. But they could not continue because of several side effects and nephrotoxicity. They have been received etanercept at the dose of 25mg weekly or 25mg twice a week. Among 3 patients, first patient had rheumatoid arthritis for nineteen years and chronic kidney disease for eight years because of bladder cancer with metastasis to one kidney. Second patient had rheumatoid arthritis for twelve years and chronic kidney disease for eleven years because of unknown origin. Last patient had rheumatoid arthritis for eight years and chronic kidney disease for four years because of unknown origin.
We evaluated the safety of etanercept treatment in RA patients with chronic kidney disease as occurrence of adverse events and tendency of change in renal function. Efficacy was assessed the change of disease activity as DAS28-CRP and reduction of other drug dose or the change of medication pattern. Results: All of them demonstrated improvement in DAS28-CRP after etanercept treatment and reduced of other drug dose. No significant adverse events have been observed. Change in renal function were measured using the MDRD(modification of diet in renal disease) GFR. There were linear relationships between MDRD GFR and time. These mean that the change of GFR in all patients are not acute superimposed drug toxicity but chronic progressive renal failure. Conclusion: These cases show that etancercept may be an safe and effective treatment option for RA patients with chronic kidney disease. However, further randomized clinical studies are required to confirm their safety and efficacy.
