2000 Volume 56 Issue 2 Pages 38-41
The patient was a 57-year-old woman, diagnosed with RA in 1996. She was admitted to the hospital in December 1997 with a 4-mo history of intractable diarrhea. At colonoscopy there was a pancolitis, resembling ulcerative colitis especially in the transverse colon. All biopsy specimens from the colon, duodenum, and stomach showed intramucosal deposits of eosinophilic material that was antiserum against amyloid A protein-positive and Congo red-positive with apple-green birefringence. Congo red staining was abolished by prior treatment with potassium permanganate, indicating that this was amyloid of AA type. These findings established the diagnosis of amyloidosis secondary to rheumatoid arthritis. The patient had a response to therapy with MTX, colchicine and PSL, which was evaluated through clinical manifestations and endoscopic findings, and she was discharged from the hospital 6 mo later. Repeat colonoscopy at 12 mo showed a marked resolution of colitis ; colonic biopsy specimens were almost negative for amyloid. It is considered that high activity of RA induces a rapid increase of SAA and promotes the deposit of amyloid, which might contribute to the onset of intractable diarrhea, and control of the underlying RA activity results in the resolution of secondary amyloidosis with clinical and biopsy remission.
