Some remarks on management of juvenile chronic arthritis complicated by amyloidosis

A retrospective study of 66 juvenile arthritic patients with reactive amyloidosis for a mean 12 +/- 10.7 years (1 to 30 years) from the onset of amyloidosis was performed. Forty-seven of them received continuous long-term chlorambucil therapy. Nineteen remaining patients were not treated with cytostatics of less than 3 months. The mortality rate for the whole group was 54.5%. 63.8% of those treated with chlorambucil are alive (mean survival 23.1 +/- 2.5 years). All patients from untreated group died. Their mean survival was 3.2 +/- 2.2 years. Nine patients from another group had been given thymus peptides for six months. Recurrent infections of the urinary and respiratory tract was the main reason for this therapy. Follow-up of 1 to 6 years showed good therapeutic effect of thymus peptides on the disease activity, alleviation of the renal manifestations and decline in recurrent infections. Recently, immunotherapy with intravenous immunoglobulins has been applied to 13 patients with IgG deficiency, renal failure, and persistent nephrotic syndrome. Preliminary results of the immunoglobulin treatment encourage to the further study on this therapeutic method.