Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Clinic Bad Bramstedt, Oskar Alexander Strasse 26, 24576 Bad Bramstedt, Germany.
Rheumatol Int. 2012 Sep;32(9):2645-51. doi: 10.1007/s00296-011-2005-9. Epub 2011 Jul 24.
The aim of this study was to examine the frequency of amyloid deposition in patients with end-stage rheumatoid arthritis (RA) of the hip. The impact on the clinical situation and the RA severity regarding the inflammation was analyzed. Fifty patients with RA who consecutively underwent total hip replacement were prospectively evaluated. X-rays of the patients were analyzed radiologically (Larsen score) to quantify the radiological changes. A clinical score (Harris Hip Score) was preoperatively calculated from every patient. A laboratory set of inflammation markers (erythrocyte sedimentation rate, CRP, serum amyloid A-SAA, electrophoresis) was measured in every patient the day before the operation. Specimens of bone and cartilage from the femoral head and of the capsule were obtained from every patient intraoperatively for histological evaluation. A histological grading was performed. In patients with amyloid deposits, the subtypes were characterized immunohistologically. Ninety-two percent of the patients had raised SAA in the blood samples, but the only amyloid subtype was ATTR. No correlation was found for any other measured item, such as inflammation signs in the blood samples, the histological grading, the radiological or the clinical score. Amyloid plays a role in inflammatory joint destruction processes in RA with raised SAA values, but the amyloid deposits in the joint are of a different subtype. Thus, these amyloid deposits can be considered as minor pathologic significance. A correlation to the radiological and histological changes was ruled out by our study. As in degenerative arthritis, ATTR amyloid deposits may be an incidental finding in aged joints.
本研究旨在探讨处于类风湿关节炎（RA）终末期的髋关节患者的淀粉样蛋白沉积频率。分析了淀粉样蛋白沉积对炎症相关的临床情况和 RA 严重程度的影响。50 例连续接受全髋关节置换术的 RA 患者前瞻性评估。对患者的 X 射线进行放射学分析（Larsen 评分），以量化放射学变化。每位患者均在术前计算临床评分（Harris 髋关节评分）。每位患者在手术前一天测量一组炎症标志物（红细胞沉降率、CRP、血清淀粉样蛋白 A-SAA、电泳）。从每位患者的股骨头和囊内获得骨和软骨标本进行组织学评估。进行组织学分级。对有淀粉样蛋白沉积的患者，通过免疫组织化学对其亚型进行特征描述。92%的患者血液样本中 SAA 升高，但唯一的淀粉样蛋白亚型是ATTR。在血液样本中的炎症标志物、组织学分级、放射学或临床评分等任何其他测量项目中均未发现相关性。淀粉样蛋白在 RA 的炎症性关节破坏过程中起作用，但关节中的淀粉样蛋白沉积是不同的亚型。因此，这些淀粉样蛋白沉积可被认为具有较小的病理意义。本研究排除了其与放射学和组织学变化的相关性。与退行性关节炎一样，ATTR 淀粉样蛋白沉积可能是老年关节的偶然发现。
