Acute Secondary Gastrointestinal Amyloidosis in a Patient with Rheumatoid Arthritis

Secondary amyloidosis is well recognized as a severe complication in the late stages of rheumatoid arthritis (RA). However, there have been few reported cases of secondary amyloidosis developing early during the course of RA. We here report the case of a 35-year-old woman, in whom RA who had been di...

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Bibliographic Details
Published in:The American journal of the medical sciences 2003-09, Vol.326 (3), p.145-147
Main Authors: Shimoyama, Masaki, Ohtahara, Akira, Fukui, Hiroko, Okamura, Tomohisa, Shimizu, Hideki, Miyamoto, Mika, Yamawaki, Masahiro, Taniguchi, Shin-ichi, Ueda, Yoshihiko, Hisatome, Ichiro, Shigamasa, Chiaki
Format: Article
Language:English
Subjects:
Acute Disease
Adrenal Cortex Hormones - metabolism
Adult
Amyloidosis - diagnosis
Amyloidosis - pathology
Arthritis, Rheumatoid - complications
Biological and medical sciences
Congo Red - pharmacology
Diseases of the osteoarticular system
Female
Gastrointestinal Diseases - pathology
Humans
Immunosuppressive agents
Immunosuppressive Agents - pharmacology
Inflammatory joint diseases
Intravenous hyperalimentation
Medical sciences
Methotrexate - pharmacology
Recurrence
Rheumatoid arthritis
Secondary amyloidosis
Time Factors
Watery diarrhea
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Summary:Secondary amyloidosis is well recognized as a severe complication in the late stages of rheumatoid arthritis (RA). However, there have been few reported cases of secondary amyloidosis developing early during the course of RA. We here report the case of a 35-year-old woman, in whom RA who had been diagnosed 1year before, with intractable watery diarrhea as a symptom of RA-induced secondary intestinal amyloidosis. Combination treatment with intravenous hyperalimentation, corticosteroids, and methotrexate (MTX) resulted in a dramatic improvement of her symptoms and objective findings of serological abnormalities. Subsequent administration of corticosteroids and MTX resulted in long-term survival without recurrence. This case indicates that we should be alert for the development of secondary amyloidosis, even in patients with a short history of RA, when the disease is active. Furthermore, combination therapy with intravenous hyperalimentation and strong immunosuppressive agents seems to be very efficacious in the treatment of RA-associated secondary intestinal amyloidosis.
ISSN:0002-9629
1538-2990
DOI:10.1097/00000441-200309000-00008