Lesson of the month
A concealed cause of recurrent renal failure in a patient with juvenile chronic arthritis
J Hamilton, P Balint, M Field, R D Sturrock
Centre for Rheumatic
Diseases, University Department of Medicine, Glasgow Royal Infirmary,
10 Alexandra Parade, Glasgow G31 2ER
Correspondence to: Dr J Hamilton.
Accepted for publication 26 March 1999
| The first 150 words of the full text of this article appear below. |
 |
Case report |
|---|
A 20 year old man with a 17 year history of systemic onset
juvenile chronic arthritis (JCA) was admitted with a fever of 38.2°C with increasing joint pain especially at the right hip. Numerous disease modifying agents including corticosteroids had been tried previously, but despite this his disease remained sub-optimally controlled and at age 14 he was diagnosed as having renal amyloid on
the basis of proteinuria and an iodine-123-serum amyloid
P (123 I-SAP) scan and started on treatment with
chlorambucil. Bilateral hip replacements were performed but revision
surgery was required to the right hip one year later complicated by low
grade sepsis with staphylococcus epidermidis. Although mobility
remained significantly impaired becuse of the consequences of his hip
disease, by the age of 17 sequential 123 I-SAP scanning
demonstrated that the amyloid load was small. At that stage he had
little in the way of active joint disease. The chlorambucil dose was
tapered and stopped.
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