Association between clinical parameters and amyloid-positive area in gastroduodenal biopsy in reactive amyloidosis associated with rheumatoid arthritis.
Our study was aimed to clarify an association between gastrointestinal (GI) amyloid-positive area and various kinds of factors including renal function in reactive amyloidosis associated with rheumatoid arthritis (RA). Twenty-five patients with an established diagnosis of reactive AA amyloidosis participated in the study between January 1989 and December 2009. Each patient satisfied the 1987 American Rheumatism Association criteria for RA. All patients showed amyloid deposits in both of GI and renal tissues. The average amyloid-deposited area was 2.2% in renal tissues and 3.7% in GI tissues although the difference was not statistically significant. Twenty-two patients out of 25 patients showed less than 5% of amyloidosis in renal tissues and nineteen patients showed 5% of amyloidosis in GI tissues. In 5 out of a total of 25 cases, the amyloid-deposited area in GI tissues was lesser than that in renal tissues. Mesangial proliferative glomerulonephritis, thin basement membrane disease (TBMD) and membranous nephropathy were frequently combined with renal amyloidosis. For statistical analyses, renal and GI tissues of % amyloid-positive areas were transformed to common logarithmic values (Log(10)%amyloid), since the histograms showed log-normal distribution. Clinical data were assessed by patient record at the time of GI biopsy. The correlation between Log(10)%GI-amyloid and age, creatinine (Cr), creatinine clearance (Ccr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR) were not significantly associated with Log(10)%GI-amyloid in crude correlation analyses and also in sex- and age-adjusted linear regression analyses. Although GI biopsy was not correlated with clinical factors, GI amyloid-positive areas were larger than renal amyloid-positive areas. Endoscopic screening of the upper GI tract is common in Japan, and amyloid-deposited area in GI tissues was sufficient to use for the diagnosis of amyloidosis compared with renal tissues in terms of convenience and sensitivity.
Niigata University Health Administration Center, 2-8050 Ikarashi, Nishi-ku, Niigata City 950-2181, Japan. kurodat@med.niigata-u.ac.jp
Takeshi
T
Kuroda
Naohito
N
Tanabe
Daisuke
D
Kobayashi
Hiroe
H
Sato
Yoko
Y
Wada
Shuichi
S
Murakami
Masaaki
M
Nakano
Ichiei
I
Narita
D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000473:pathology*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000150:complications / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged
Jpn J Med. 1990 May-Jun;29(3):274-82
2273606
Ann Rheum Dis. 2003 Sep;62(9):897-900
12922967
Medicine (Baltimore). 1978 Jul;57(4):319-27
661557
Baillieres Best Pract Res Clin Rheumatol. 1999 Dec;13(4):615-28
10652643
Lancet. 2001 Jul 7;358(9275):24-9
11454373
J Rheumatol. 2003 Jun;30(6):1196-202
12784389
Br J Rheumatol. 1996 Jan;35(1):44-9
8624622
Arch Intern Med. 1983 Aug;143(8):1549-52
6191729
J Rheumatol. 2003 May;30(5):948-51
12734887
Clin Nephrol. 1998 Sep;50(3):154-60
9776418
Medicine (Baltimore). 1991 Jul;70(4):246-56
2067409
Br Med J. 1962 Feb 10;1(5275):364-7
13892291
Gastrointest Endosc. 1990 Jan-Feb;36(1):10-4
2311879
Mod Rheumatol. 2002 Jun;12(2):148-54
24383903
Ann Rheum Dis. 1984 Jun;43(3):440-3
6742907
Arthritis Rheum. 1995 Feb;38(2):242-7
7848315
Ann Rheum Dis. 1997 Sep;56(9):535-41
9370878
Am J Kidney Dis. 2007 Dec;50(6):927-37
18037093
Rheumatology (Oxford). 2007 Feb;46(2):350-7
16908509
Ann Rheum Dis. 2002 Jan;61(1):42-7
11779757
Lancet. 1962 Apr 7;1(7232):721-4
13870184
Clin Exp Rheumatol. 2007 Jul-Aug;25(4):518-22
17888205
Arthritis Rheum. 2006 Mar;54(3):692-701
16508929
Arthritis Rheum. 2006 Sep;54(9):2997-3000
16947531
Arthritis Rheum. 1988 Mar;31(3):315-24
3358796
Hum Pathol. 1985 Dec;16(12):1206-11
4065883
Gastrointest Endosc. 1971 May;17(4):137-44
5087334
Clin Rheumatol. 2002 May;21(2):123-8
12086162
Clin Exp Rheumatol. 1985 Apr-Jun;3(2):173-80
3893817
J Rheumatol. 2009 Nov;36(11):2409-15
19797512
Arthritis Rheum. 2005 Mar;52(3):722-32
15751097