Research Article
Volume 7 Issue 3 - 2020
AA Amyloidosis and Lung Diseases in Rheumatoid Arthritis - A Postmortem Clinicopathologic Study of 147 Autopsy Patients
Miklós Bély1* and Ágnes Apáthy2
1Department of Pathology, Hospital of the Order of the Brothers of Saint John of God, Hungary
2Department of Rheumatology, St. Margaret Clinic, Budapest, Hungary
*Corresponding Author: Miklós Bély, Department of Pathology, Hospital of the Order of the Brothers of Saint John of God, Hungary.
Received: February 14, 2020; Published: February 29, 2020


Aim of the Study: The aim of this study was to determine the incidence of systemic AA amyloidosis (sAAa) in rheumatoid arthritis (RA), to identify the amyloid A deposition on different tissue structures of the lung (pAAa), and assess the influence of sAAa and pAAa on lung diseases related or not related to RA.

Patients and Methods: 147 random autopsy patients with RA were studied. RA was confirmed clinically according to the criteria of the ARA.

The prevalence (existence) and severity (extent) of sAAa and pAAa was specified histologically. Amyloid A deposition was diagnosed histologically according to Romhányi by a modified (more sensitive) Congo red staining.

Distinct forms of multifocal inflammation, such as purulent bronchitis or bronchiolitis (purBr), bronchopneumonia (BrPn), infarct pneumonia (InfPn), obliterative pneumonia (OblPn), rheumatoid pneumonia (RhPn), furthermore interstitial pneumonia (IPn) were determined post-mortem and analyzed retrospectively, reviewing the clinical and pathological reports.

Demographics of different patient cohorts were compared with the Student t-probe. The possible role of sAAa or pAAa on the prevalence of purBr or BrPn, InfPn, OblPn, RhPn and IPn was analyzed with chi-squared ( χ2) test.

Results: sAAa complicated RA in 34 (23.13%) of 147 patients. Branches of pulmonary and bronchial blood vessels were involved in 25 (73.53%) of these 34 cases.

PurBr or BrPn were associated with RA in 18 (12.23%), InfPn in 5 (3.4%), OblPn in 2 (1.4%), RhPn in 3 (2.1%) of 147 patients (only the fatal cases were considered). IPn was present in 35 (23.8% of 147) patients and contributed to the death only in association with cardiac, circulatory or cardio-respiratory insufficiency.

Conclusion: sAAa or pAAa may develop in both sexes, and at any time in the course of RA. According to our study interstitial pneumonia (IPn) is influenced by sAAa or pAAa. The relatiomship between pAAa and obliterative pneumonia (OblPn) seems to be more direct. Lung diseases, such as purulent bronchitis or bronchiolitis (purBr), bronchopneumonia (BrPn), infarctpneumonia (InfPn), rheumatoid pneumonia (RhPn) are independent entities.

Keywords: Systemic and Pulmonary Amyloidos; Lung Diseases


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Citation: Miklós Bély and Ágnes Apáthy. “AA Amyloidosis and Lung Diseases in Rheumatoid Arthritis - A Postmortem Clinicopathologic Study of 147 Autopsy Patients”. EC Cardiology 7.3 (2020): 01-17.

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