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Rheumatology 2003; 42: 362-366
© 2003 British Society for Rheumatology

Grand Rounds in Rheumatology

Cytostatic therapy for AA amyloidosis complicating psoriatic spondyloarthropathy

S. Mpofu, L. S. Teh1, P. J. Smith1, R. J. Moots and P. N. Hawkins2

Academic Rheumatology Unit, University Hospital Aintree, Liverpool L9 7AL,
1 Blackburn Royal Infirmary, Bolton Road, Blackburn BB2 3LR and
2 National Amyloidosis Centre, Department of Medicine, Royal Free and University College Medical School, Royal Free Campus, London NW3 2PF, UK

Abstract

Psoriatic spondyloarthropathy (PSA) can occasionally be complicated by AA amyloid, and renal amyloidosis should be suspected in patients with PSA who have unexplained proteinuria. The diagnosis of amyloidosis can be made either histologically or by radiolabelled serum amyloid P component (SAP) scintigraphy. Prognosis is determined by the extent of organ involvement and associated impairment of function, and by the degree of response of the underlying disease to anti-inflammatory therapy. A review of the literature identified less than a dozen cases of AA amyloidosis complicating PSA, and the outcome in most cases was poor. We report here the favourable clinical course of a middle-aged Caucasian male patient with severe PSA who developed renal AA amyloidosis, in whom treatment with oral chlorambucil led to stabilization of the amyloid deposits and resolution of the associated nephrotic syndrome. We review the diagnosis and treatment of AA amyloidosis, including the management of patients with underlying inflammatory spondyloarthropathies, and propose the possible role of a therapeutic trial of anti-tumour necrosis factor {alpha} in patients with amyloid complicating inflammatory rheumatic diseases.

KEY WORDS: Psoriatic spondyloarthropathy, AA amyloidosis, Chlorambucil, Anti-TNF.

Notes

Correspondence to: S. Mpofu. E-mail: tsujoy{at}aol.com


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