Prevalence of amyloid deposition in long standing rheumatoid arthritis in Iranian patients by abdominal subcutaneous fat biopsy and assessment of clinical and laboratory characteristics

Roya Setarehshenas,Nasrin Shayanfar,G Hussein Alishiri,Jafar Forghanizadeh,Mohammad Bagher Owlia,Ahmad Salimzadeh

doi:10.1186/1471-2474-7-43

Abstract

BackgroundThe study was aimed at determining the prevalence of secondary amyloidosis in a group of Iranian patients with Rheumatoid Arthritis (RA), and the assessment of its correlation with the clinical and laboratory findings and data.MethodA total number of 220 patients (167 female and 53 male) with a minimum five-year history of RA were selected. Congo red staining method was used for staining the specimens obtained by abdominal subcutaneous fat biopsy (ASFB) method. All of the specimens were examined for apple-green birefringence under polarized light microscope. Clinical and laboratory characteristics of the patients were assessed. Chi-square test and unpaired student's t-test were run for intergroup comparisons.ResultsAmyloid deposition test yielded positive results in 15 out of the 220 cases (6.8%) examined by the ASFB technique. Thirteen patients were found to have minimal amyloid deposits. Of all the clinically significant cases, 8 (53%) presented with proteinuria, and 7 cases (46.6%) had severe constipation.ConclusionThe prevalence of fat amyloid deposits in Iranian patients with RA is low. In up to half of the study group the deposits were subclinical. Follow up studies are required to determine whether this subclinical amyloidosis can develop into full-blown clinically significant amyloidosis.

Highlights

The study was aimed at determining the prevalence of secondary amyloidosis in a group of Iranian patients with Rheumatoid Arthritis (RA), and the assessment of its correlation with the clinical and laboratory findings and data
Follow up studies are required to determine whether this subclinical amyloidosis can develop into full-blown clinically significant amyloidosis
A greater number of the patients who tested positive for amyloid deposition presented with higher functional disability class than the ones that tested negative for amyloid deposition (P < 0.05)

Summary

Introduction

The study was aimed at determining the prevalence of secondary amyloidosis in a group of Iranian patients with Rheumatoid Arthritis (RA), and the assessment of its correlation with the clinical and laboratory findings and data. Reactive or secondary amyloidosis is a well-known significant late complication of chronic inflammatory disease, especially rheumatoid arthritis (RA) [1]. In this condition, large amounts of amyloid molecules (of the AA type) are deposited over a wide area. The main clinical manifestations of secondary amyloidosis (SA) are marked proteinuria and gastrointestinal symptoms. The disease carries a poor prognosis, and causes death in 2–9% of the cases [2,3]

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Discussion

Conclusion