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THU0129 Urogenital AA Amyloidosis in Rheumatoid Arthritis – A Postmortem Clinicopathologic Study of 234 Autopsy Patients
  1. Ά. Apáthy1,
  2. M. Bély2
  1. 1Department of Rheumatology, St. Margaret Clinic
  2. 2Department of Pathology, of the Order of the Brothers of Saint John of God, Budapest, Hungary

Abstract

Background AA amyloidosis (AAa) is one of the main complications of rheumatoid arthritis (RA). All visceral organs may be involved to various degrees.

Objectives The aim of this study was to determine the prevalence, and severity of amyloid A deposits in male urogenital organs of RA patients.

Methods A randomized autopsy population of 234 in-patients with RA was studied. AAa complicated RA in 48 (20.5%) of 234 cases (females 38, and males 10). RA was diagnosed clinically according to the criteria of the American College of Rheumatology (ACR).

The existence of amyloid A deposits in male urogenital organs were determined histologically. The “severity” (extent) of amyloid A deposits was evaluated by semi-quantitative, visual estimation on a 0 to 3 plus scale, based on the number of involved blood vessels per light microscopic field (x40 objective of an Olympus BX51).

Results The prevalence and the average amount of amyloid A deposits in male urogenital organs are summarized in Table 1, and demonstrated in Figure 1

Table 1.

Prevalence (in % of involved organs) and the amoumt the amyloid A deposits (in % of maximal value of 3) in urogenital organs of 10 male RA patients afflicted with amyloidosis

Conclusions Amyloid A precursors are produced by the liver and via the blood stream deposit in various organs according to the blood perfusion (1). The rate and amount of amyloid deposition in organs is basically determined by their volume and by the volume of blood per minute reaching those (2).

The deposition of amyloid A is more pronounced in kidneys, testis or prostate than in the epididymis or penis. Kidney, prostate or testes (because the high prevalence and massivity of amyloid A deposits) – like the gastrointestinal tract – could be a good target for biopsy to diagnose amyloidosis. Biopsy of prostate is less stressful than biopsy of kidneys.

The risk of AAa is high in RA, therefore all tissue samples – regardless of the reason for removal – is suggested to be screened for amyloiosis in any case.

The diagnosis of amyloidosis depends on the specificity and sensitivity of the applied method. Using a less sensitive staining method some positive cases – with minimal amyloid deposits – remain undetected. The more specific and sensitive Congo red staining according to Romhányi is suggested for detection of amyloid deposits in comparison with Puchtler's Congo red methods (3).

References

  1. Bély M, Apáthy Ά. Histochemical and immunohistichemical differential diagnosis of amyloidosis - a brief illustrated essay and personal experience with Romhányi's method. Amyloid, 2000; 7:212-217.

  2. Bély M, Apáthy Ά, Pintér T, Ratkό I. Generalized secondary amyloidosis in rheumatoid arthritis. Acta Morph. Acad Sci Hung 1992;40:49-69.

  3. Bély M, Makovitzky J. Sensitivity and Specificity of Congo red Staining According to Romhányi - Comparison with Puchtler's or Bennhold's Methods. Acta Histochemica, 2006; 108:175-180

Disclosure of Interest None declared

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