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AB0259 The Changing Face of Rheumatoid Arthritis and AA Amyloidosis – A Postmortem Clinicopathologic Study of 237 Rheumatoid Arthritis Patients
  1. Ά. Apáthy1,
  2. M. Bély2
  1. 1Department of Rheumatology, St. Margaret Clinic
  2. 2Department of Pathology, Hospital of the Order of the Brothers of Saint John of God in Budapest, Budapest, Hungary

Abstract

Background According to some clinicians the course of rheumatoid arthritis (RA) has been changing in the last decades. However, AA amyloidosis (AAa) remains one of the most important complications of RA [1].

Objectives The aim of this study was to verify this clinical impression, the “changing face of RA”, characterized by AAa.

Methods At the National Institute of Rheumatology 12138 patients died between 1969 and 2000; among them 237 with RA, and all of them were autopsied.

This non-selected autopsy population of 237 was the subject of present study. In 49 (20.68%) of 237 patients, RA was complicated by AAa.

RA was confirmed clinically according to the criteria of the American College of Rheumatology (ACR). The existence of AAa was determined histologically. The extent of amyloid A deposition/patient was evaluated by semi-quantitative visual estimation on a 0 to 3 plus scale. The average incidence of AAa was calculated in percentage of the number of RA patients, who died during four periods of time (8–8–8-8 years) covering 32 years (between 1969 and 2000).

Results Demographics, duration and onset of disease (in years) of RA patients with AAa is summarized in Table 1, as well as the average incidence of AAa in RA between 1969 and 2000 in Figure 1.

During these four periods of time (1969 to 2000) the average age of the RA patients with AAa continuously increased somewhat (from 56.71 to 64.08 years). In the four periods RA was diagnosed increasingly earlier in life (42.43 years versus 46.5) and the course of the disease became longer (20.71 years versus 12.00).

The average incidence of AAa continuously increased (from 10.77% to 30.0%) between 1969 and 2000. This was due to the raised prevalence of mild AAa (the proportion of cases with severe AAa decreased (from 6.15% to 4.0%).

Conclusions The earlier onset of RA and the longer life span may explain the changing face of RA and/or the more effective therapy. The increased incidence of AAa may be related to the longer duration of the inflammation.

The changing proportion of severe and mild amyloid deposition, i.e. the decrease of severe cases has likely been related to the introduction of more effective immunosuppressive therapy.

Our data from the end of the last century allow comparison with the changes following the introduction of the much more effective biological therapy of the present.

  1. Bély M, Apáthy Άgnes: Clinical Pathology of rheumatoid arthritis: Cause of death, lethal complications and associated diseases in rheumatoid arthritis. First English edition, 1–440 pp. Akadémiai Kiadό, Budapest 2012 http://www.akkrt.hu/p>

Disclosure of Interest None declared

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