Amyloidosis is a common complication of rheumatoid arthritis. Renal disease is the main manifestation and its usual outcome is the lost of renal function. Some clinical evidences suggest that low-dose treatment with chlorambucil may be effective as therapy of this complication.
The effect of chlorambucil treatment in a group of six patients diagnosed by renal biopsy of renal amyloidosis secondary to rheumatoid arthritis was evaluated. Patients were treated with 0.1 mg/kg body weight/day for a time above a year until reduction of proteinuria.
3 out of 6 patients showed decrease of proteinuria below 500 mg/day, two patients have started renal replacement therapy and one died without response to treatment. It was detected non reversible azoospermia in one patient. Mean follow-up time has been sixty months.
Chlorambucil may be effective in the treatment of renal amyloidosis secondary to rheumatoid arthritis when treatment starts before renal function is impaired. Long term remissions can be obtained even after suspending treatment.