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Min, Yoon, Kim, Kim, Kim, Kwok, Park, Kim, and Ju: Secondary Amyloidosis Development in a Patient with Juvenile Rheumatoid Arthritis on TNF-α Inhibitors Treatment
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(5): 280-284.

Published online: 31 October 2012

DOI: https://doi.org/10.4078/jrd.2012.19.5.280

Secondary Amyloidosis Development in a Patient with Juvenile Rheumatoid Arthritis on TNF-α Inhibitors Treatment

Hong Ki Min, Moon-Hee Yoon, Eun-Oh Kim, Dae-Won Kim, Nam-Yong Kim, Seung-Ki Kwok, Sung-Hwan Park, Ho-Youn Kim, Ji Hyeon Ju

Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Corresponding to: Ji Hyeon Ju, Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul 137-040, Korea. juji@catholic.ac.kr

Received 16 October 2011       Revised 23 October 2011       Accepted 25 October 2011

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Secondary amyloidosis is one of the most serious complications in chronic inflammatory diseases such as rheumatoid arthritis. The extracellular deposit of aggregates of amyloid leads to target organ dysfunction. The mainstay treatment of secondary amyloidosis is the control of underlying disease activity. Many reports have reported that TNF-α inhibitors improve clinical outcomes. Here, we encountered a 34-year-old patient with juvenile rheumatoid arthritis who developed secondary amyloidosis despite treatment with TNF-α inhibitors. We present this case and include a review of the literature.

Keywords: TNF-α inhibitor, Rheumatoid arthritis, Amyloidosis

Figures and Tables

Figure 1
X-ray of sacroiliac joint. Partial fusion of both sacroiliac joints.
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Figure 2
X-ray of knee both AP (stand). Uniform joint space narrowing and periarticular osteopenia.
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Figure 3
(A) Esophagogastroduodenoscopy, (B) Colonoscopy. (A) Severe atropic change at body and pylorus of stomach, (B) Diffuse petechiae and inflammation and spontaneous bleeding.
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Figure 4
Congo red with polarizing microscope (×100). Moderate chronic inflammation and marked glandular atrophy, as well as amorphous eosinophilic deposits suggestive of amyloidosis (birefringence of apple green color) at the stomach.
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Figure 5
Transthoracic echocardiogram. Severe concentric left ventricular hypertrophy with systolic kissing phenomenon, infiltrative CMP due to fine ground glass appearance of myocardium of left ventricle.
jrd-19-280-g005

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