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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2002 Jan;61(1):42–47. doi: 10.1136/ard.61.1.42

Screening for amyloid in subcutaneous fat tissue of Egyptian patients with rheumatoid arthritis: clinical and laboratory characteristics

T M El Mansoury 1, B Hazenberg 1, S A El Badawy 1, A Ahmed 1, J Bijzet 1, P Limburg 1, M H van Rijswijk 1
PMCID: PMC1753881  PMID: 11779757

Abstract

Objective: To screen for amyloid and to assess associated clinical and laboratory characteristics in Egyptian patients with rheumatoid arthritis (RA).

Methods: Abdominal subcutaneous fat aspirates were consecutively collected from 112 patients (103 women, nine men) having RA for five years or more. To detect amyloid, fat smears were stained with Congo red and the concentration of amyloid A protein in fat tissue was measured. Clinical, radiological, and laboratory characteristics of the patients were assessed.

Results: Amyloid was detected in eight (7%) of the fat smears stained with Congo red. Compared with the Congo red stain, the sensitivity for detecting amyloid by measurement of amyloid A protein in fat tissue was 75% and the specificity was 100%. The amount of amyloid found was small for both methods. The median disease duration of the eight amyloid patients was significantly longer (17 years) than that of the non-amyloid patients (10 years). Bronchopulmonary disease and constipation were more common, whereas proteinuria and chronic renal insufficiency were not. The number of swollen joints and the number of red blood cells were significantly lower in the amyloid group.

Conclusions: Quantification of amyloid A protein and staining with Congo red are strongly concordant methods of screening for amyloid in fat tissue. The prevalence of amyloid in Egyptian patients with RA is 7%. Proteinuria is not a discriminating feature, whereas long disease duration, constipation, bronchopulmonary symptoms, and a moderate to low number of red blood cells may help to identify the arthritic patients with amyloid.

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Figure 1 .

Figure 1

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Quantification of amyloid A protein in fat tissue (µg/mg protein) of the eight patients with a positive Congo red stain and the 104 patients with a negative Congo red stain. Horizontal lines indicate median values and the three asterisks indicate the difference (p<0.0001) between the median values of both groups. The dashed line (D) indicates the upper limit (1.3 µg/mg protein) of a group of Dutch controls without AA amyloidosis.

Figure 2 .

Figure 2

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The amyloid patients, matched non-amyloid patients, and the remaining non-amyloid patients. Horizontal lines indicate median values and the asterisks indicate the differences (*p<0.05; **p<0.01; ***p<0.005; NS, not significant) between the median values of the groups. (A) Number of swollen joints (maximum 38); (B) number of deformed joints (maximum 38); (C) serum amyloid A protein (SAA) concentration (mg/l); (D) number of red blood cells (RBC) x1012/l.

Figure 3 .

Figure 3

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Disease duration and number of red blood cells (RBC) of the amyloid patients (black squares) and the non-amyloid patients (circles). Dashed lines represent disease duration (10 years) and RBC (4.56x1012/l), respectively.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Bahabri S., Al-Sewairi W., Al-Mazyad A., Karrar A., Al-Ballaa S., El-Ramahai K., Al-Dalaan A. Juvenile rheumatoid arthritis: The Saudi Experience. Ann Saudi Med. 1997 Jul;17(4):413–418. doi: 10.5144/0256-4947.1997.413. [DOI] [PubMed] [Google Scholar]
  3. Breedveld F. C., Markusse H. M., MacFarlane J. D. Subcutaneous fat biopsy in the diagnosis of amyloidosis secondary to chronic arthritis. Clin Exp Rheumatol. 1989 Jul-Aug;7(4):407–410. [PubMed] [Google Scholar]
  4. Cohen A. S. Amyloidosis. N Engl J Med. 1967 Sep 7;277(10):522–contd. doi: 10.1056/NEJM196709072771006. [DOI] [PubMed] [Google Scholar]
  5. Falk R. H., Comenzo R. L., Skinner M. The systemic amyloidoses. N Engl J Med. 1997 Sep 25;337(13):898–909. doi: 10.1056/NEJM199709253371306. [DOI] [PubMed] [Google Scholar]
  6. Ferraz M. B., Quaresma M. R., Aquino L. R., Atra E., Tugwell P., Goldsmith C. H. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol. 1990 Aug;17(8):1022–1024. [PubMed] [Google Scholar]
  7. Filipowicz-Sosnowska A. M., Baum J. The amyloidosis of juvenile rheumatoid arthritis--comparative studies in Polish and American children. IV. Is endotoxin a precipitory factor? Scand J Rheumatol. 1980;9(1):24–30. doi: 10.1080/03009748009098123. [DOI] [PubMed] [Google Scholar]
  8. Fries J. F., Spitz P. W., Young D. Y. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982 Sep-Oct;9(5):789–793. [PubMed] [Google Scholar]
  9. Gratacos J., Orellana C., Sanmarti R., Sole M., Collado A., Gomez-Casanovas E., de Dios Canete J., Munoz-Gomez J. Secondary amyloidosis in ankylosing spondylitis. A systematic survey of 137 patients using abdominal fat aspiration. J Rheumatol. 1997 May;24(5):912–915. [PubMed] [Google Scholar]
  10. Gómez-Casanovas E., Sanmartí R., Solé M., Cañete J. D., Muñoz-Gómez J. The clinical significance of amyloid fat deposits in rheumatoid arthritis: a systematic long-term followup study using abdominal fat aspiration. Arthritis Rheum. 2001 Jan;44(1):66–72. doi: 10.1002/1529-0131(200101)44:1<66::AID-ANR10>3.0.CO;2-H. [DOI] [PubMed] [Google Scholar]
  11. Hamdan J., Manasra K., Ilahi F. Amyloidosis secondary to juvenile rheumatoid arthritis: a case report from Saudi Arabia. Ann Trop Paediatr. 1986 Dec;6(4):279–282. doi: 10.1080/02724936.1986.11748456. [DOI] [PubMed] [Google Scholar]
  12. Hazenberg B. P., Limburg P. C., Bijzet J., van Rijswijk M. H. A quantitative method for detecting deposits of amyloid A protein in aspirated fat tissue of patients with arthritis. Ann Rheum Dis. 1999 Feb;58(2):96–102. doi: 10.1136/ard.58.2.96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Husby G. Amyloidosis and rheumatoid arthritis. Clin Exp Rheumatol. 1985 Apr-Jun;3(2):173–180. [PubMed] [Google Scholar]
  14. Jager P. L., Hazenberg B. P., Franssen E. J., Limburg P. C., van Rijswijk M. H., Piers D. A. Kinetic studies with iodine-123-labeled serum amyloid P component in patients with systemic AA and AL amyloidosis and assessment of clinical value. J Nucl Med. 1998 Apr;39(4):699–706. [PubMed] [Google Scholar]
  15. Janssen S., Van Rijswijk M. H., Meijer S., Ruinen L., Van der Hem G. K. Systemic amyloidosis: a clinical survey of 144 cases. Neth J Med. 1986;29(11):376–385. [PubMed] [Google Scholar]
  16. Khuffash F. A., Majeed H. A. Juvenile rheumatoid arthritis among Arab children. Scand J Rheumatol. 1988;17(5):393–395. doi: 10.3109/03009748809105276. [DOI] [PubMed] [Google Scholar]
  17. Klemi P. J., Sorsa S., Happonen R. P. Fine-needle aspiration biopsy from subcutaneous fat. An easy way to diagnose secondary amyloidosis. Scand J Rheumatol. 1987;16(6):429–431. doi: 10.3109/03009748709165414. [DOI] [PubMed] [Google Scholar]
  18. Kobayashi H., Tada S., Fuchigami T., Okuda Y., Takasugi K., Matsumoto T., Iida M., Aoyagi K., Iwashita A., Daimaru Y. Secondary amyloidosis in patients with rheumatoid arthritis: diagnostic and prognostic value of gastroduodenal biopsy. Br J Rheumatol. 1996 Jan;35(1):44–49. doi: 10.1093/rheumatology/35.1.44. [DOI] [PubMed] [Google Scholar]
  19. Maury C. P., Teppo A. M. Rheumatoid factors and amyloidosis in rheumatoid arthritis. Br Med J (Clin Res Ed) 1985 Oct 12;291(6501):1015–1016. doi: 10.1136/bmj.291.6501.1015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mitwalli A. H., Al Wakeel J. S., Al Mohaya S. S., Malik H. G., Abu-Aisha H., Hassan O. S., Akhtar M. Pattern of glomerular disease in Saudi Arabia. Am J Kidney Dis. 1996 Jun;27(6):797–802. doi: 10.1016/s0272-6386(96)90516-8. [DOI] [PubMed] [Google Scholar]
  21. Rawashdeh M. O., Majeed H. A. Familial Mediterranean fever in Arab children: the high prevalence and gene frequency. Eur J Pediatr. 1996 Jul;155(7):540–544. doi: 10.1007/BF01957901. [DOI] [PubMed] [Google Scholar]
  22. Ritchie D. M., Boyle J. A., McInnes J. M., Jasani M. K., Dalakos T. G., Grieveson P., Buchanan W. W. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed] [Google Scholar]
  23. Simms R. W., Prout M. N., Cohen A. S. The epidemiology of AL and AA amyloidosis. Baillieres Clin Rheumatol. 1994 Aug;8(3):627–634. doi: 10.1016/s0950-3579(05)80119-0. [DOI] [PubMed] [Google Scholar]
  24. Sobh M., Refaie A., El-Tantawy A. E., Saad M., Said E., Arif S., El-Sherif A., Ghoneim M. Study of neuromyopathy in amyloid kidney transplant patients. Am J Nephrol. 1996;16(2):114–117. doi: 10.1159/000168981. [DOI] [PubMed] [Google Scholar]
  25. Thompson P. W., Silman A. J., Kirwan J. R., Currey H. L. Articular indices of joint inflammation in rheumatoid arthritis. Correlation with the acute-phase response. Arthritis Rheum. 1987 Jun;30(6):618–623. doi: 10.1002/art.1780300603. [DOI] [PubMed] [Google Scholar]
  26. Tiitinen S., Kaarela K., Helin H., Kautiainen H., Isomäki H. Amyloidosis--incidence and early risk factors in patients with rheumatoid arthritis. Scand J Rheumatol. 1993;22(4):158–161. doi: 10.3109/03009749309099264. [DOI] [PubMed] [Google Scholar]
  27. Westermark P., Stenkvist B. A new method for the diagnosis of systemic amyloidosis. Arch Intern Med. 1973 Oct;132(4):522–523. [PubMed] [Google Scholar]
  28. Yahya T. M., Pingle A., Boobes Y., Pingle S. Analysis of 490 kidney biopsies: data from the United Arab Emirates Renal Diseases Registry. J Nephrol. 1998 May-Jun;11(3):148–150. [PubMed] [Google Scholar]
  29. van Leeuwen M. A., Westra J., Limburg P. C., de Jong H. J., Marrink J., van Rijswijk M. H. Quantitation of IgM, IgA and IgG rheumatoid factors by ELISA in rheumatoid arthritis and other rheumatic disorders. Scand J Rheumatol Suppl. 1988;75:25–31. doi: 10.3109/03009748809096735. [DOI] [PubMed] [Google Scholar]

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