Amyloidosis is frequently undetected in patients with rheumatoid arthritis.
Prevalence of AA amyloid in rheumatoid arthritis (RA) is still unclear. The objective of this retrospective study was whether dedicated re-examination of autopsy tissues from RA patients increases the detection rate of amyloid compared to routine examination. Amyloid was re-examined in tissue samples and detection rate compared with original reports of 369 consecutively autopsied RA patients and 370 non-RA patients matched for sex, age, and year of autopsy between 1952 and 1991. Re-examination of 90% of the 739 cases showed doubling of the prevalence of amyloid compared with the original reports: from 18 to 30% in RA and from 2 to 4% in non-RA patients. In RA patients, cardiac amyloid was as frequent as renal amyloid. In RA patients with amyloid at re-examination, amyloidosis had been diagnosed before autopsy in 37%, and these patients had more inflammation and longer disease duration than RA patients without amyloid. Only 56% of RA patients with renal amyloid were known to have proteinuria. In conclusion, this autopsy study shows that amyloid in RA is a common finding which remains frequently undetected. In patients with active and long-lasting RA, a systematic search for amyloid may enable early diagnosis of amyloidosis, which will require effective suppression of inflammation.
Koivuniemi
Riitta
R
Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. riitta.koivuniemi@hus.fi
Paimela
Leena
L
Suomalainen
Risto
R
Tornroth
Tom
T
Leirisalo-Repo
Marjatta
M
D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000378:metabolism / Q000401:mortality; D001344:Autopsy; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein / Q000378:metabolism
D000685:Serum Amyloid A Protein