Journal List > J Korean Rheum Assoc > v.15(4) > 1003640

Baek, Song, Lee, Lee, Sung, Hwang, and Hur: A Case of Treatment with Etanercept in Rheumatoid Arthritis Patient on Hemodialysis

Abstract

Disease-modifying antirheumatic drugs (DMARDs) have been used for rheumatoid arthritis (RA) with the aim of controlling synovitis and reducing radiologic progression. Although methotrexate (MTX) is one of the most effective DMARDs, it may cause severe adverse effects. Especially, hematologic toxicity including leukopenia, thrombocytopenia, and fatal pancytopenia is reported in patients with impaired renal function, since renal excretion constitutes the major route of MTX elimination. Tumor necrosis factor-α (TNFα) inhibitors are well-established biologic agents for the treatment of RA and their clinical efficacy and safety are already demonstrated. But there were few reports on the efficacy and safety in dialysis patients. We described a case of hemodialysis patient with refractory RA that was successfully treated with etanercept, and discussed with literature review.

References

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Fig. 1.
The alteration of erythrocyte segmentation rate (ESR) and C-reactive protein (CRP) according to etanercept.
jkra-15-317f1.tif
Fig. 2.
Time course of pain severity (assessed by visual analogue scale).
jkra-15-317f2.tif
Table 1.
Risk factors and outcomes in patients with methotrexate-related pancytopenia
  Gutierrez-Urena et al. (8) Lim et al. (2) Kuitunen et al. (10)
No. of patients 70 25 18
Median age (years) NA 76 72
Median MTX dose (range) 8.2 mg/week (5∼15) 12.5 mg/week (7.5∼25) 5∼30 mg/week
Total MTX dose (mg) 10∼4,800 NA 12.5∼3,000
Duration of Tx (weeks) NA 156 (24∼480) 30 (2∼300)
Renal insufficiency (%) 38 (54) 5 (20) 8 (44)
Hypoalbuminemia (%) 17 (24) 18 (72) NA
Mortality (%) 12 (17) 7 (28) 8 (44)

NA: not available, MTX: methotrexate, Tx: therapy

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