Generalized secondary amyloidosis in rheumatoid arthritis.

The autopsy material of 215 RA patients was studied to determine 1) the frequency of generalized secondary amyloidosis (GSA), 2) the frequency and extent of amyloid deposits in various organs, 3) the chronological succession of amyloid deposition in various organs. The tissue specimens were fixed in 8% formaldehyde solution and embedded in paraffin. Serial sections were cut and stained with HE and Congo-red according to Romhányi, without alcoholic differentiation. The average amount of amyloid deposition in various organs was determined on a 0 to 4 plus scale. Thirty-seven cases were found to contain stainable amyloid (17.2%). The frequency and degree of amyloid deposition in different organs of RA cases with GSA are summarized in the following table. [table: see text] The frequency and extent of amyloid deposits in various organs may be linked to the ratio of cardiac output distributed over a different tissue mass. In conclusion, the tissues and organs often showing high quantities of amyloid are the sites where the deposits begin. Where deposits are infrequent or of low quantity deposits develop later. Amyloid deposits early in the wall of blood vessels, first of all within the GI tract, heart, kidneys, thyroid gland, spleen and the adrenal glands.