TITLE:
Systemic Amyloidosis Secondary to Psoriasis: A Rare, Autoimmune and Genetically-Determined Disorder That Is Amenable to Treatment with Cyclosporin A—Cyclosporin A for Psoriasis-Induced Amyloidosis
AUTHORS:
Kamel El-Reshaid, Shaima Al-Bader, John Patrick Madda
KEYWORDS:
Amyloidosis, Psoriasis, Nephrotic Syndrome, Cyclosporin A
JOURNAL NAME:
Open Journal of Nephrology,
Vol.14 No.2,
June
13,
2024
ABSTRACT: Background: Systemic secondary amyloidosis (SSA) is associated with chronic inflammatory disorders and/or chronic infections. Patients and Methods: Over the past 10 years; a total of 21 patients, with long-term (≥17 months) and extensive psoriasis (P) with psoriasis area severity index (PASI) >29, were evaluated. Results: Two patients had nephrotic syndrome (proteinuria 3.9 and 3.6 g/day) and decrease creatinine clearance (46 and 62 ml/minute). Their renal biopsy revealed Congo-red (+) nodular glomerulosclerosis that lacked immune-deposits and resisted wash with K-permanganate wash indicating SSA. Three months subsequent to Cyclosporin A (CyA) therapy with 100 mg twice daily; psoriasis improved in all patients with decrease in (PASI) from ≥29.5 to ≤3.5 1. In the 2 patients with SSA; proteinuria decreased to 2.1 and 1.8 g/day and creatinine clearance improved to 51 and 69 ml/minute. Such improvement persisted up to ≥2 years of follow up and up to ≥78 months in patients with SSA. Conclusion: psoriasis-induced SSA is an autoimmune disease, with genetic predisposition that is amenable to CyA therapy.