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Birnbrich AM, Orozco EI, Holderread BM, Liberman SR, McCulloch PC. Amyloid deposition in the glenohumeral joint: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:201-204. [PMID: 37587950 PMCID: PMC10426642 DOI: 10.1016/j.xrrt.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Alysa M. Birnbrich
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Erin I. Orozco
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Brendan M. Holderread
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shari R. Liberman
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Patrick C. McCulloch
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
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Muchtar E, King RL, McPhail ED, Thorpe MP, Gonsalves W, Ernste F, Grogan M, Dispenzieri A, Gertz MA. Amyloid arthropathy in smoldering myeloma: Do not take it lightly. Leuk Res Rep 2021; 15:100242. [PMID: 33996437 PMCID: PMC8105656 DOI: 10.1016/j.lrr.2021.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022] Open
Abstract
We report a case of smoldering multiple myeloma patient who developed signs and symptoms consistent with polyarthritis. A PET-CT demonstrated marked FDG activity in multiple joints, concerning for inflammatory arthritis. Arthrocentesis from the glenohumeral joint was consistent with inflammatory synovial fluid with no evidence for infection or crystals. Congo-red stain of the synovial fluid was positive, and mass-spectrometry based amyloid typing was consistent with wild-type transthyretin type. The patient responded instantly to glucocorticoids. This case reports highlights the feasibility of non-tissue diagnosis of amyloidosis using body fluids and underscores the importance of accurate typing to avoid erroneous treatment
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Affiliation(s)
- Eli Muchtar
- Division of Hematology Mayo Clinic Rochester, MN, United States
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Matthew P Thorpe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Floranne Ernste
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | | | - Morie A Gertz
- Division of Hematology Mayo Clinic Rochester, MN, United States
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Hoffman JE, Dempsey NG, Sanchorawala V. Systemic Amyloidosis Caused by Monoclonal Immunoglobulins: Soft Tissue and Vascular Involvement. Hematol Oncol Clin North Am 2020; 34:1099-1113. [PMID: 33099427 DOI: 10.1016/j.hoc.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical features of soft tissue amyloid light-chain (AL) amyloidosis include macroglossia, arthropathy, muscle pseudohypertrophy, skin plaques, and carpal tunnel syndrome. Vascular manifestations of AL amyloid include periorbital ecchymosis, jaw or limb claudication, and even myocardial infarction caused by occlusion of small vessel coronary arteries. Some of these features, such as macroglossia, periorbital ecchymosis, and the so-called shoulder-pad sign, are pathognomonic for AL amyloidosis. These findings may be the initial presenting features of the disease, and the recognition of these red flag symptoms is very important for the diagnosis and early intervention on the underlying plasma cell disease.
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Affiliation(s)
- James E Hoffman
- Department of Medicine, Division of Hematology, University of Miami/Sylvester Comprehensive Cancer Center, 1475 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Naomi G Dempsey
- Department of Medicine, Division of Hematology, University of Miami/Sylvester Comprehensive Cancer Center, 1475 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Vaishali Sanchorawala
- Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, K-503, Boston, MA 02118, USA.
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Legrand M, Nouvier M, Paulin L, Deschamps B, Pialat JB, Coury F. [A systemic disease mimicking a rheumatoid arthritis]. Rev Med Interne 2019; 40:831-836. [PMID: 31444022 DOI: 10.1016/j.revmed.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Rare systemic diseases such as amyloidosis can mimic inflammatory rheumatic diseases. Because of their poor prognosis, physicians should rule them out at the onset of inflammatory rheumatism. We report a case of AL amyloidosis misdiagnosed as rheumatoid arthritis. CASE REPORT A 71-year-old woman was referred for seronegative rheumatoid arthritis, resistant to three biologic therapies. She had an IgA lambda monoclonal gammopathy of undetermined significance (MGUS). The patient subsequently developed glomerular proteinuria. Abdominal fat and accessory salivary glands biopsies revealed amyloid light-chain (AL) amyloidosis. Treatment with bortezomib-cyclophosphamide-dexamethasone, led to complete hematologic, renal and rheumatologic remission. Ten months after treatment interruption, the patient had an articular and hematologic relapse. CONCLUSION Amyloid light-chain amyloidosis arthropathy is probably underdiagnosed. A review of amyloid arthropathy associated with multiple myeloma found that 33% of patients had been misdiagnosed with rheumatoid arthritis.
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Affiliation(s)
- M Legrand
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France.
| | - M Nouvier
- Service de néphrologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - L Paulin
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - B Deschamps
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France
| | - J B Pialat
- Université Lyon 1, 69007 Lyon, France; Service d'imagerie médicale et interventionnelle, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Service d'imagerie médicale et interventionnelle, Hospices civils de Lyon, hôpital Édouard-Herriot, 69003 Lyon, France
| | - F Coury
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France
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Manzo A, Bugatti S, Rossi S. Clinical Applications of Synovial Biopsy. Front Med (Lausanne) 2019; 6:102. [PMID: 31134204 PMCID: PMC6524205 DOI: 10.3389/fmed.2019.00102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
The synovial tissue is a primary target of multiple diseases characterized by different pathogenic mechanisms, including infective, deposition, neoplastic, and chronic immune-inflammatory pathologies. Synovial biopsy can have a relevant role in differential diagnosis of specific conditions in clinical practice, although its exploitation remains relatively limited. In particular, no validated synovial-tissue-derived biomarkers are currently available in the clinic to aid in the diagnosis and management in most frequent forms of chronic inflammatory arthropathies, namely rheumatoid arthritis (RA) and the spondyloarthritides (SpA). In this brief review, we will discuss the current spectrum of clinical applications of synovial biopsy in routine rheumatologic care and will provide an analysis of the perspectives for its potential exploitation in patients with chronic inflammatory arthritides.
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Affiliation(s)
- Antonio Manzo
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Serena Bugatti
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Silvia Rossi
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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[Synovial fluid cytodiagnosis]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 53:100-112. [PMID: 32199591 DOI: 10.1016/j.patol.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/05/2019] [Accepted: 01/16/2019] [Indexed: 11/23/2022]
Abstract
Synovial fluid samples represent only a very small percentage of routine work in a cytology laboratory. However, its microscopic examination allows us to observe different types of cells, particles and structures that, due to their morphological characteristics, may provide relevant data for cytodiagnosis. We present certain aspects related to arthrocentesis, the relationship between the gross appearance of synovial fluid and certain pathological processes, as well as the different techniques for processing and staining the smears. Furthermore, we describe the main cytological findings in various pathological conditions of the synovial joints, such as infections (bacterial and fungal), non-infectious inflammatory type (osteoarthrosis, rheumatoid arthritis, connective tissue diseases) and tumoral, distinguishing between primary and metastatic, both solid and haematological neoplasms.
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Andrei IA, Kuntzer T, Lobrinus JA, Jaccard A, Zufferey P. Neuroarthropathy of the foot revealing primary systemic amyloidosis: case report and literature review. Clin Rheumatol 2014; 35:535-9. [DOI: 10.1007/s10067-014-2782-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/07/2014] [Indexed: 12/19/2022]
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M'Bappé P, Grateau G. Osteo-articular manifestations of amyloidosis. Best Pract Res Clin Rheumatol 2012; 26:459-75. [DOI: 10.1016/j.berh.2012.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 07/17/2012] [Indexed: 12/11/2022]
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Parrón Cambero R, Rivera I, Santacruz Arévalo A. Amiloidosis de cadera. Presentación de un caso y revisión de la bibliografía. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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Amyloidosis of the hip. Presentation of a case and a review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recote.2011.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Iyer RS, Bhargava P, Medverd JR. A 65-year-old man presents with pelvic pain. Skeletal Radiol 2010; 39:1151-2. [PMID: 20405125 DOI: 10.1007/s00256-010-0899-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ramesh S Iyer
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195, USA.
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Punzi L, Oliviero F. Arthrocentesis and Synovial Fluid Analysis in Clinical Practice. Ann N Y Acad Sci 2009; 1154:152-8. [DOI: 10.1111/j.1749-6632.2009.04389.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gisserot O, Landais C, Cremades S, Terrier JP, Leyral G, Bernard P, de Jauréguiberry JP. Amyloid arthropathy and Waldenström macroglobulinemia. Joint Bone Spine 2006; 73:456-8. [PMID: 16087379 DOI: 10.1016/j.jbspin.2005.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 03/01/2005] [Indexed: 12/17/2022]
Abstract
Amyloid arthropathy occurs chiefly as a manifestation of beta(2) microglobulin amyloidosis in patients receiving chronic hemodialysis. AL amyloidosis complicating multiple myeloma is a less common cause. Amyloid arthropathy is exceedingly rare in patients with Waldenström macroglobulinemia. We report a case characterized by lymphoplasmocytoid malignancy with monoclonal IgM production and amyloid arthropathy manifesting as bilateral symmetric polyarthritis. A synovial membrane biopsy established the diagnosis. Chemotherapy was effective in alleviating the joint manifestations. Joint symptoms in patients with monoclonal gammopathies, including those characterized by IgM secretion, should suggest amyloid arthropathy. Treatment of the blood disease may improve the joint symptoms.
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Affiliation(s)
- Olivier Gisserot
- Internal Medicine and Oncology Department, Sainte-Anne Armed Forces Teaching Hospital, 83800 Toulon Naval, France.
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Grau JM, Payá A, Reus S, Manzi F. [Edema in lower limbs and scrotum in a 66-year-old male]. Med Clin (Barc) 2002; 119:66-72. [PMID: 12084373 DOI: 10.1016/s0025-7753(02)73315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Josep M Grau
- Servicio de Medicina Interna, Hospital Clínic de Barcelona, Spain
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Shiraishi M, Ando Y, Mizuta H, Nakamura E, Takagi K, Ando M. Charcot knee arthropathy with articular amyloid deposition in familial amyloidotic polyneuropathy. Scand J Rheumatol 1997; 26:61-4. [PMID: 9057805 DOI: 10.3109/03009749709065667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An extremely rare case of familial amyloidotic polyneuropathy (FAP) complicated by neuroarthropathy (Charcot joint) in the left knee joint and by intra-articular deposits of amyloid was observed. FAP-specific variant transthyretin (TTR) was found in the synovial fluid and amyloid deposits were confirmed in the synovium, cartilage and bone by Congo red staining and immuno-staining.
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Affiliation(s)
- M Shiraishi
- Department of Orthopaedic Surgery, Kumamoto University School of Medicine, Japan
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Affiliation(s)
- E Pascali
- Institute of General Clinical Medicine, University of Trieste, Cattinara Hospital, Italy
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Hazenberg BP, van Rijswijk MH. Clinical and therapeutic aspects of AA amyloidosis. BAILLIERE'S CLINICAL RHEUMATOLOGY 1994; 8:661-90. [PMID: 7954868 DOI: 10.1016/s0950-3579(05)80121-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Approach to the management of AA amyloidosis complicating RA. (A) In case of proteinuria or loss of renal function a rectal biopsy or a subcutaneous fat biopsy is a suitable screening method for the detection of amyloidosis. If in any doubt, try to ascertain the diagnosis by renal biopsy. Adequate staining with alkaline Congo red and preferably immunohistochemical staining with anti-AA antibodies should be performed. Beware of renal pathology other than amyloidosis even in the presence of a positive rectal biopsy. (B) A vigorous attempt to control disease activity of the RA should be made in order to eliminate the production of SAA, an acute phase protein. The response to treatment should be monitored by serial measurements of CRP and preferably SAA. (C) The function of some vital organs should be evaluated: (a) endogenous creatinine clearance and the extent of proteinuria; (b) electrocardiogram and optional echocardiography; (c) thyroid function and adrenocortical function; (d) intestinal absorption tests; (e) optional--SAP scintigraphy and turnover studies. (D) Attention should be given to adequate supportive treatment: (a) blood pressure control; (b) treatment of intercurrent infections; (c) corticosteroids during major surgical procedures; (d) pay attention to the possible effect of NSAID on proteinuria and renal function. (E) In case of total renal failure or uncontrollable proteinuria: (a) consider the possibility of primary renal transplantation; (b) otherwise regular haemodialysis is indicated.
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Affiliation(s)
- B P Hazenberg
- Division of Rheumatology, University Hospital Groningen, The Netherlands
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Affiliation(s)
- R A Kyle
- Mayo Medical School, Rochester, Minnesota
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Abstract
Primary systemic amyloidosis (immunoglobulin light chain-derived) (AL) is an uncommon dysproteinemia with highly varied initial clinical manifestations. Among 153 patients with this disorder, the median survival was 20.4 months (5-year survival, 19.6%). The worst outcome was associated with overt congestive heart failure (median survival, 7.7 months; 5-year survival, 2.4%). The patients with the best outcome were those who had amyloid neuropathy without associated cardiac or renal involvement (median survival, 39.7 months; 5-year survival, 31.6%). Serum protein electrophoresis and immunoelectrophoresis are the most important tests because a monoclonal protein can be detected in almost two-thirds of the patients. When screening of both serum and urine is performed, a monoclonal protein is found in 86% of patients. Such screening is helpful if primary systemic amyloidosis is to be detected and treated early.
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Affiliation(s)
- M A Gertz
- Dysproteinemia Clinic, Mayo Clinic, Rochester, MN 55905
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