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Amyloidosis is frequently undetected in patients with rheumatoid arthritis

Riitta Koivuniemi1, Leena Paimela, Risto Suomalainen

  • 1Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. riitta.koivuniemi@hus.fi

Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis
|December 10, 2008
PubMed

Insights

Amyloidosis is common in rheumatoid arthritis (RA) but often missed. Re-examining autopsy tissues doubled amyloid detection rates in RA patients, highlighting the need for early diagnosis and inflammation control.

Area of Science:

  • Rheumatology
  • Pathology
  • Nephrology

Background:

  • The prevalence of AA amyloidosis in rheumatoid arthritis (RA) is not well-established.
  • Routine examination of autopsy tissues may underestimate amyloid detection rates in RA patients.

Purpose of the Study:

  • To determine if dedicated re-examination of autopsy tissues increases amyloid detection in RA patients compared to routine examination.
  • To compare amyloid prevalence in RA patients versus non-RA controls.

Main Methods:

  • Retrospective analysis of autopsy tissues from 369 RA patients and 370 matched non-RA controls (1952-1991).
  • Re-examination of tissue samples and comparison with original autopsy reports.
  • Analysis of clinical data including inflammation, disease duration, and proteinuria.

Main Results:

  • Re-examination doubled amyloid prevalence from 18% to 30% in RA patients and from 2% to 4% in non-RA patients.
  • Cardiac and renal amyloid were equally frequent in RA patients.
  • Only 37% of RA patients with amyloidosis had a prior diagnosis; 56% with renal amyloid had proteinuria.

Conclusions:

  • AA amyloidosis is a frequent, often undetected, complication in rheumatoid arthritis.
  • Systematic amyloid screening in active, long-standing RA may facilitate early diagnosis.
  • Effective inflammation suppression is crucial for managing amyloidosis in RA.

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