Twenty-two patients with definite or classical rheumatoid arthritis (RA) who were diagnosed as amyloidosis by biopsy or at autopsy were investigated. The average duration of RA prior to the diagnosis of amyloidosis was 16.5 +/- 12.5 years. The symptoms that led to the diagnosis of amyloidosis were renal symptoms in 11 cases and gastrointestinal symptoms in 5 cases. Urinary protein was positive in 16 cases (73%). The degree of proteinuria varied in each case. Nephrotic syndrome was observed in 5 cases. Azotemia (Cr greater than 1.5 mg/dl) was present in 18 cases (82%). The period from the diagnosis of amyloidosis to death was 3.0 +/- 2.2 years. The causes of death were uremia in 10 cases, heart failure in 2 cases, malignancy in 2 cases, sepsis in 2 cases and others in 2 cases. Thirteen patients were autopsied and the frequency of amyloidosis complicated with RA was 22.0% in autopsied rheumatoid patients. Although nephropathy was present in most cases of amyloidosis complicated with RA, proteinuria and azotemia greatly varied in both degree and course.

Adult↗

PubMedDate not supplied

Thrombocytopenia subsequently develops systemic lupus erythematosus--can anti-SS-A antibody predict the next event?

In order to detect diagnostic clues to identify patients with chronic immune thrombocytopenia which is likely to develop systemic lupus erythematosus (SLE), a retrospective study was conducted. Of 39 patients with chronic immune thrombocytopenia, 4 fulfilled the diagnostic criteria being between 4.5 and 14 years after the initial diagnosis of "idiopathic" thrombocytopenic purpura. The remaining 35 patients were found to be idiopathic thrombocytopenic purpura (ITP) after at least a 5-year follow-up. It was noted that in patients with SLE who had thrombocytopenia at presentation, only 4 or 5 findings of diagnostic criteria were observed. Of particular interest, all patients who developed SLE were positive for anti-SS-A antibody, in contrast none of the patients with ITP had this antibody. Furthermore, despite the few clinical manifestations, we noted lupus peritonitis in 1 patient and pulmonary hypertension in another patient. In conclusion, the anti-SS-A antibody is an excellent clue for the early detection of SLE occurring as "idiopathic" thrombocytopenic purpura.

Antibodies, Antinuclear↗