Amyloidosis in Rheumatoid Arthritis, and Significance of "Unexplained" Albuminuria

Fearnley, G. R.; Lackner, Rita

doi:10.1136/bmj.1.4922.1129

Cited by 37 publications

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References 4 publications

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“…Amyloidosis is a rare complication, estimates varying from 1 in 100 cases (Schlesinger et al, 1961) to 11 in 316 (Ansell and Bywaters, 1956). This is in contrast to adult rheumatoid arthritis in which the incidence of amyloid ranges from 4% (Fearnley and Lackner, 1955) to 15% (Missen and Taylor, 1956), and even as high as 60% (Teilum and Lindahl, 1954). Amyloid deposition was marked in the present case, in particular in the kidney where there was virtual replacement of all glomeruli.…”

Section: Discussionmentioning

confidence: 99%

Extensive vascular calcification in association with juvenile rheumatoid arthritis and amyloidosis.

Reid¹,

Fannin²

1968

Archives of Disease in Childhood

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Amyloidosis is an uncommon complication of juvenile rheumatoid arthritis. Forsyth (1960) described such a case, where, in additon, there was small vessel calcification. The following report of a similar case is of interest in view of the extensive arterial calcification, amyloidosis, and arteritis seen at necropsy. Case HistoryA.D. was a normal boy until the age of 21 years when he was admitted to hospital with a history of one week's anorexia, pyrexia, difficulty in walking, and generalized pains. There was a rash over the abdomen and pain in his hip and knee joints. The only laboratory findings of note were a white cell count of 23,000 (polymorphs 75%) and Hb 9-6 g./100 ml. He was treated with penicillin and streptomycin, made a good recovery, and was discharged after one month in hospital.When aged 21 years the fever and generalized pains recurred and he was again admitted to hospital. He was thin with painful swellings of both wrists, and reduced cervical spine movement; and had splenomegaly, generalized lymphadenopathy, and a faint erythematous rash over the trunk and hands. Temperature 40. 5 C.ESR 58 mm./1 hr.; Hb 8-9 g./100 ml.; WBC 48,000, with 86% polymorphs; serum protein 6-6%, albumin 2-9%, globulin 3-7%; urine, albumin+. X-ray of wrist showed slight decalcification.He was given soluble aspirin for one month, but then relapsed and was treated with prednisone, 20 mg./day, with marked improvement, and he was eventually discharged when aged 3j years on no treatment.A month later there was a recurrence of the arthralgia, rash, and pyrexia. Again there was a poor response to salicylate treatment, and gold therapy was started, but after a single injection of 1 mg. soluble aurothiomalate he became jaundiced: serum alkaline phosphatase was then 106 KA units, SGOT 160 units, and SGPT 175 units.No further gold was given and prednisone was restarted. Aged 4 years 1 month he was discharged on 5 mg. prednisone twice weekly, being fully mobile and having no joint pains. He remained well, and steroid therapy was stopped a year later. Received March 25, 1968. When aged 8j years he developed jaundice at the same time as his mother and two sibs. In addition, he had abdominal pain and a generalized morbilliform rash. He was transferred to hospital as he was vomiting and had developed abdominal swelling. On examination he was thin and jaundiced. The large joints were swollen and tender. There was marked ascites and hepatosplenomegaly.Hb 12-9 g./100 ml.; WBC 20,000, polymorphs 71%; platelets 746,000 per cu.mm.; serum protein 3* 9%; albumin 1 *04%; oal-globulin 0*36%; acx-globulin 0*67%; ,-globulin 0-75%; Treatment. A low protein-high carbohydrate diet, and oral neomycin, prednisone, aldactone, chlorothiazide, and potassium chloride were given in view of hepatic failure, exacerbation of rheumatoid arthritis, and fluid retention.He vomited blood on several occasions, and barium swallow suggested early oesophageal varices. Extensive bruising now appeared and he required analgesics for relief of retrosternal and upper ab...

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Section: Discussionmentioning

confidence: 99%

Extensive vascular calcification in association with juvenile rheumatoid arthritis and amyloidosis.

Reid¹,

Fannin²

1968

Archives of Disease in Childhood

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“…Many authors have pointed out that the first clinical sign of amyloidosis is usually albuminuria. Fearnley and Lackner (1955) screened 183 patients with rheumatoid arthritis and found 24 with proteinuria. Seven of these had amyloidosis, proved either by liver biopsy or the congo red test.…”

Section: Incidencementioning

confidence: 99%

Amyloidosis in Rheumatoid Arthritis: INVESTIGATED BY MEANS OF RECTAL BIOPSY

Arapakis¹,

Tribe²

1963

Annals of the Rheumatic Diseases

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“…In life the overall incidence of amyloid in rheumatoid arthritis is 4% (Fearnley and Lackner, 1955) and should be suspected in any patient with persistent and prolonged activity of the arthritis who has proteinuria, hepatomegaly, or splenomegaly. Summary A case of perforation of the gall-bladder in a patient with rheumatoid arthritis treated with prednisone is described.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Acute Primidone Poisoning with Bemegride and Amiphenazole

Dotevall¹,

Herner²

1957

BMJ

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inflamed than the mucosa, and the cell reaction was largely polymorphonuclear. The outer surface showed peritonitis of apparently some days' duration. An occasional Grampositive coccus was seen. Special staining revealed amyloid deposits in small vessels and in the basement membrane. DiscussionThe diagnosis of peritonitis was based on the sudden onset of upper abdominal pain radiating to the right iliac fossa and acute abdominal tenderness, followed later by rigidity and absence of bowel sounds. In retrospect, the episode three days-previously was one of perforation with local peritonitis, and this was supported by histological examination. Before operation the gall-bladder was not suspected as the seat of disease, and it is probable that a reflex pylorospasm was responsible for the symptom-complex.The significance of the relationship of onset of dyspepsia to the starting of treatment with prednisone is difficult to assess. It is known that peptic ulceration occurs more frequently with prednisone than with cortisone, but cholecystitis has not yet been described as a complication of either of these drugs. Because of deterioration in the general condition associated with persistent vomiting, prednisone was replaced by intramuscular cortisone. The stress associated with surgical trauma was covered by intravenous hydrocortisone.Corticotrophin has been found to bring the temperature and pulse rate to normal levels within 12-36 hours after its administration (Beck et al., 1950). lt also causes a decrease of the leucocytes during the first few hours, with lymphopenia and eosinopenia. In the reported cases of patients undergoing treatment with corticotrophin and cortisone we found that the physical signs of all underlying diseases were obscured and there was a delay in diagnosis due to the reduction of inflammatory response caused by these drugs.When an operation is contemplated on a patient undergoing treatment with corticotrophin and cortisone, care must be taken to ensure that large doses of cortisone are given immediately before and after the operation, because there is a possibility that, without taking this precaution, the patient may develop post-operative adrenal cortical insufficiency due to stress (Salassa et al., 1953). As cortisone was withdrawn, adrenal stimulation with intramuscular corticotrophin was maintained. Adequate dosage of corticosteroids must be ensured, otherwise clinical features of adrenal cortical insufficiency develop quickly, the most important being restlessness, nausea, vomiting, weakness, hypotension, and coma. In treating the adrenal cortical deficiency state, intravenous hydrocortisone-the quickest therapeutic agent-gives an almost immediate response; oral cortisone acts in four to six hours, and intramuscular cortisone more slowly.Because the severity of the post-operative renal failure was more marked than could be accounted for by the transient oliguria, the possibility of amyloidosis was considered and a special staining technique confirmed this in the specimen removed. Two months ...

show abstract

Amyloidosis in Rheumatoid Arthritis, and Significance of "Unexplained" Albuminuria

Cited by 37 publications

References 4 publications

Extensive vascular calcification in association with juvenile rheumatoid arthritis and amyloidosis.

Extensive vascular calcification in association with juvenile rheumatoid arthritis and amyloidosis.

Amyloidosis in Rheumatoid Arthritis: INVESTIGATED BY MEANS OF RECTAL BIOPSY

Treatment of Acute Primidone Poisoning with Bemegride and Amiphenazole

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