Two cases of rheumatoid arthritis (RA) with amyloidosis, causing xerostomia, diagnosed by labial salivary gland biopsy are reported.
Case 1, a 65-year-old female who had been suffered from RA for eighteen years, and congestive heart failure and renal insufficiency for three years, was admitted because of general fatigue and vomiting. Laboratory findings on admission were as follows: the erythrocyte sedimentation rate was 72mm/hour, CRP 12.0 mg/d
l, blood urea nitrogen 875 mg/d
l, serum creatinine 3.5 mg/d
l, RAHA 1:2, 560, antinuclear antibody negative, antibodies to SS-A and SS-B negative, cryoglobulin negative. The urine gave a + test for protein and the sediment normal. On examination she complained of severe xerostomia. Her labial salivary gland biopsy showed deposition of amyloid around salivary ducts and acini. She was diagnosed as secondary amyloidosis in RA. Congestive heart failure, paralytic ileus and renal function became gradually worse, and she died. At necropsy she was diagnosed as generalized amyloidosis.
Case 2, a 64-year-old female who had been suffered from RA for fifteen years, was admitted because of fever and chillness. Laboratory findings were as follows: the erythrocyte sedimentation rate was 45mm/hour, CRP 13.8mg/d
l, blood urea nitrogen 27.3mg/d
l, serum creatinine 1.4mg/d
l, RAHA 1:160, antinuclear antibody negative, antibodies to SS-A and SS-B negative. The urine gave a ± test for protein and the sediment normal. She had no congestive heart failure and no gastrointestinal symptoms in the past. On admission she had renal insufficiency and complained of severe xerostomia. Her labial salivary gland biopsy revealed deposition of amyloid. Renal insufficiency was thought to be due to amyloidosis. Her general condition had been getting better.
Our cases showed that xerostomia in RA might be due to not only Sjögren Syndrome but also amyloidosis, and that labial salivary gland biopsy had proved to be a sensitive method for diagnosis of amyloidosis in RA.
View full abstract