Rheumatoid Amyloidosis

Maury, C.P., M. Liljestrom, S. Tiitinen, K. Laiho, K. Kaarela, and C. Ehnholm. 2001. Apolipoprotein E phenotypes in rheumatoid arthritis with or without amyloidosis. Amyloid. 8 270-3. 

In one series of some 5500 patients with juvenile rheumatoid arthritis, 105 were found to have developed secondary amyloidosis 37 of the latter had been receiving sodium aurothiomalate. In 12 of these children the time between withdrawal of gold (because of adverse effects) and the finding of amyloid A was less than six months (SEDA-21,237). 

A 63-year-old woman with rheumatoid arthritis was given intramuscular gold sodium thiomalate and began to have nausea, vomiting, anorexia, and watery diarrhea (71). A year later the watery diarrhea became more frequent (more than 10 times within a day) and she developed proteinuria. Biopsies from the stomach, duodenum, and kidney showed systemic amyloidosis. This was a rare case of secondary systemic amyloidosis associated with rheumatoid arthritis. It is not clear from the report what the role of gold was in this case. 

Tahara K, Nishiya K, Yoshida T, Matsubara Y, Matsumori A, Ito H, Kumon Y, Hashimoto K, Moriki T, Ookubo S. [A case of secondary systemic amyloidosis associated with rheumatoid arthritis after 3-year disease duration.] Ryumachi 1999 39(l) 27-32. 

Secondary paraproteinemias may be seen in association with hematopoietic cancers (e.g., lymphomas and leukemias), other neoplasms (e.g., colon carcinoma), long-standing chronic urinary or biliary tract infection, rheumatoid factor related to IgM monoclonal protein, and amyloidosis. 

Lymphadenopathy may occur in patients with rheumatoid arthritis, particularly in nodes proximal to more actively involved joints. Renal involvement is rare but can be associated with treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs), gold salts, and penicillamine. Amyloidosis is a rare complication of long-standing rheumatoid arthritis. It appears to be more common in Europe than in the United States. 

Forslund, T., Rummukainen, M., Kousa, M., Krees, R., Relander, A., and Katila, M. L. (1995). Disseminated cutaneous infection due to Mycobacterium chelonae in a patient with rheumatoid arthritis, amyloidosis, and renal failure. Nephrol. Dial. Transplant. 10, 1234-1236. 

In AL amyloidosis, amyloid is formed from degradation products of the X or k light chains that deposit most frequently in the extracellular matrix of the kidney and the heart but also may deposit in the tongue. In other types of amyloidosis, the amyloid arises from other proteins and deposits in a characteristic organ. For example, the amyloid associated with chronic inflammatory conditions, such as tuberculosis or rheumatoid arthritis, is derived from an acute phase serum protein called serum amyloid Athat is produced by the liver in response to inflammation. It deposits most frequently in the kidney, and cardiac involvement is rare. 

Urinary tract A 72-year-old woman with rheumatoid arthritis, secondary amyloidosis, and steroid-induced diabetes mellitus, who was taking glucocorticoids and low-dose methotrexate, developed an emphysematous pyelonephritis [76 ]. 

Four cases of pleural effusion and biopsy-proven pleural amyloid infiltration in patients with AA amyloidosis have been reported in the past 30 years (17-19). Three cases occurred in patients with long-standing rheumatoid arthritis and the remaining patient had cystic fibrosis. No amyloid-related pleural effusions have been reported in FMF. The rarity of pleural effusions in AA amyloidosis is further evidenced by the absence of pleural disease at autopsy in 113 A A patients (14), a registry of 287 Turkish AA patients (36), or autopsies of 7 patients— despite bronchial waU or pulmonary vessel amyloid deposition in over 70% (13). 

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