AA amyloidosis in inflammatory joint diseases in the era of biological therapies: Prevalence, manifestations, management and evolution - 02/07/26
Highlights |
• | The prevalence of inflammatory joint disease (IJD)-related AA amyloidosis (AAA) has become low in industrialized countries in the era of biological treatments, when patients receive a correct diagnosis and treatment. |
• | However, it has not completely disappeared and it mainly affects vulnerable populations, such as migrant and native patients with low socio-economic backgrounds. |
• | In these populations, delays in diagnosis and treatment lead to uncontrolled inflammation for years, thereby promoting the development of AAA. |
• | Systematic screening for AAA is therefore recommended in these vulnerable populations. |
• | In patients with IJD-related AAA, biological disease-modifying anti-rheumatic drugs can lead to clinical remission of IJD, substantial improvement in AAA manifestations, significant reduction of C-reactive protein and serum amyloid A levels and proteinuria, as well as stabilization of AAA progression. Hence, at least some of the organ damage could be reversible and accessible to partial healing. |
Abstract |
Objectives |
AA amyloidosis (AAA) is a complication of chronic inflammation whose burden is expected to decrease in the era of biological therapies. We assessed the prevalence, clinical and laboratory manifestations, management and evolution of AAA in patients with inflammatory joint diseases (IJDs).
Methods |
We retrospectively assessed adults followed from 2008 to 2025 in 2 French tertiary university hospitals. AAA had to be histologically confirmed and related to one of the following IJDs: rheumatoid arthritis, spondylarthritis, juvenile idiopathic arthritis, undifferentiated arthritis or gout.
Results |
The prevalence of rheumatoid arthritis- and spondylarthritis-related AAA was low, estimated at 0.6‰ and 0.5‰, respectively. We identified 15 patients with IJD-related AAA: 5 rheumatoid arthritis, 4 spondylarthritis, 2 juvenile idiopathic arthritis, 3 undifferentiated arthritis and 1 gout. Ten (66.7%) patients were from developing countries. All patients experienced delays in diagnosis and treatment. At AAA diagnosis, most patients (80%) were not receiving any treatment for IJD. AAA clinical manifestations were mainly renal and digestive; the median (interquartile range) C-reactive protein level was 41.5 (16.8–59.5) mg/L, serum amyloid A level 31 (13–44) mg/L and proteinuria/creatinuria ratio 3.5 (1.3–5.2) g/mmol. Biological disease-modifying anti-rheumatic drugs were started in 14 patients (1 patient lost to follow-up) and resulted in clinically inactive disease in 57.2%; normal C-reactive protein and serum amyloid A and proteinuria negativity in 71.4%.
Conclusion |
In the last 2 decades, AAA occurred in only patients with IJDs who experienced long diagnostic and therapeutic delays, mainly related to country of origin and difficulties in access to care.
Le texte complet de cet article est disponible en PDF.Keywords : AA amyloidosis, Rheumatoid arthritis, Spondylarthritis, Psoriatic arthritis, Gout, Juvenile idiopathic arthritis, Undifferentiated arthritis, Biological disease-modifying anti-rheumatic drugs
Plan
Vol 93 - N° 4
Article 106053- juillet 2026 Retour au numéro
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