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[A systemic disease mimicking a rheumatoid arthritis]
M Legrand1, M Nouvier2, L Paulin3
1Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France.
La Revue De Medecine Interne
|August 25, 2019
Summary
Amyloid light-chain (AL) amyloidosis can mimic rheumatoid arthritis, leading to misdiagnosis. Early identification and treatment are crucial for managing this rare systemic disease and preventing complications.
Area of Science:
- Rheumatology
- Nephrology
- Hematology
Background:
- Rare systemic diseases like amyloidosis can present with symptoms mimicking inflammatory rheumatic conditions.
- Promptly ruling out amyloidosis is essential due to its poor prognosis in patients with suspected inflammatory rheumatism.
Observation:
- A 71-year-old woman with seronegative rheumatoid arthritis resistant to multiple biologic therapies was evaluated.
- She had a history of IgA lambda monoclonal gammopathy of undetermined significance (MGUS) and developed glomerular proteinuria.
- Biopsies confirmed amyloid light-chain (AL) amyloidosis, a rare systemic disease.
Findings:
- Treatment with bortezomib-cyclophosphamide-dexamethasone achieved complete hematologic, renal, and rheumatologic remission.
- However, the patient experienced a relapse in articular and hematologic status ten months after treatment cessation.
- Amyloid light-chain amyloidosis arthropathy is likely underdiagnosed, with a significant percentage of patients misdiagnosed as having rheumatoid arthritis.
Implications:
- This case highlights the importance of considering AL amyloidosis in patients with refractory inflammatory arthritis.
- Timely diagnosis and appropriate treatment can lead to remission, but long-term monitoring is necessary.
- Increased awareness and diagnostic vigilance for amyloid arthropathy are needed in rheumatology and related fields.
Keywords:
AL (Amyloid Light - chain) amyloidosisAmylose ALGammapathie monoclonale de signification indéterminée (MGUS)Monoclonal gammopathy of undetermined significance (MGUS)PolyarthritePolyarthrite rhumatoïdePolyarthritisRheumatoid ArthritisMore Related Videos
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