Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 May 1;63(9):1311-1316.
doi: 10.2169/internalmedicine.1951-23. Epub 2023 Sep 29.

Successful Pregnancy Outcome in a Patient with Juvenile Idiopathic Arthritis in Adulthood, Amyloid A Amyloidosis, and Chronic Kidney Disease Using Tocilizumab with Strict Blood Pressure Control

Taro Akira  1 , Yukiko Shimazu  2 , Nobuhiro Hashimoto  3 , Hiroki Okushima  3 , Takehiro Suzuki  1 , Tomomi Tada  1 , Makiko Ikoma  1 , Takashi Hosokawa  1 , Yoshiyasu Ueda  3 , Masahiko Takemura  2 , Hiroshi Fujiwara  1
Affiliations
Case Reports

Successful Pregnancy Outcome in a Patient with Juvenile Idiopathic Arthritis in Adulthood, Amyloid A Amyloidosis, and Chronic Kidney Disease Using Tocilizumab with Strict Blood Pressure Control

Taro Akira et al. Intern Med. .

Abstract

Pregnancies with chronic kidney disease (CKD) and high disease activity in rheumatic diseases are high-risk events with adverse outcomes for both the mother and fetus. We herein report a 35-year-old woman with juvenile idiopathic arthritis (JIA), amyloid A (AA) amyloidosis related to JIA, and CKD stage G4A2 who wished to have children. She achieved a successful pregnancy, even in the presence of these multiple risk factors, using tocilizumab to control the disease activity of JIA and AA amyloidosis, along with antihypertensive drugs to control her blood pressure before and during pregnancy.

Keywords: Juvenile idiopathic arthritis; amyloid A amyloidosis; chronic kidney disease; pregnancy; rheumatic diseases; tocilizumab.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Radiography images of both hands at 33 years old. Bone destruction is shown in both wrist joints.
Figure 2.
Figure 2.
Course of the renal function and treatment before pregnancy. PSL: prednisolone, MTX: methotrexate, SASP: salazosulfapyridine, ADA: adalimumab, ABT: abatacept, TCZ: tocilizumab, iv: intravenous, BP: blood pressure
Figure 3.
Figure 3.
Renal biopsy findings at 25 years old. Deposition of acidophilic substances in the vessels, tubular interstitium, and glomeruli was observed. The interstitium shows fibrosis. (A) The deposits were positive for direct fast scarlet (DFS). (B) Anti-amyloid A monoclonal antibody staining. (C) Periodic acid-Schiff (PAS) staining, including glomeruli. Three glomeruli can be seen, and those on the left and in the center are collapsed due to interstitial amyloid deposition. The image on the right shows amyloid deposition in the mesangial region.
Figure 4.
Figure 4.
Pregnancy and the puerperal course. TCZ: tocilizumab, iv: intravenous, BP: blood pressure, X: date of delivery
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Giles I, Yee CS, Gordon C. Stratifying management of rheumatic disease for pregnancy and breastfeeding. Nat Rev Rheumatol 15: 391-402, 2019. - PubMed
    1. Sammaritano LR, Bermas BL, Chakravarty EE, et al. . 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Care Res (Hoboken) 72: 461-488, 2020. - PubMed
    1. Piccoli GB, Attini R, Vasario E, et al. . Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol 5: 844-855, 2010. - PMC - PubMed
    1. Konaka H, Hashimoto N, Ishizu M, et al. . Tocilizumab improves gross hematuria in an adult patient with AA amyloidosis of the urinary bladder secondary to juvenile idiopathic arthritis. Clin Rheumatol 29: 45-51, 2017.
    1. Lachmann HJ, Goodman HJ, Gilbertson JA, et al. . Natural history and outcome in systemic AA amyloidosis. N Engl J Med 356: 2361-2371, 2007. - PubMed

Publication types

MeSH terms

Supplementary concepts

-