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ID PMID Title PublicationDate abstract
15975966 The effect of etanercept on anti-cyclic citrullinated peptide antibodies and rheumatoid fa 2006 Jan OBJECTIVE: To evaluate the changes in anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) following etanercept treatment in patients with rheumatoid arthritis. METHODS: The study included 90 patients with rheumatoid arthritis who failed treatment with disease modifying antirheumatic drugs (DMARDs). All patients were allowed to continue treatment with DMARDs; 52 of them received etanercept as a twice weekly 25 mg subcutaneous injection for three months, and the others did not. Serum samples were collected at baseline and one month intervals during the treatment course. The serum levels of anti-CCP and RF were tested by enzyme linked immunosorbent assay and nephelometry, respectively. RESULTS: At baseline, 45 of the 52 etanercept treated patients (86.5%) and 32 of the 38 controls (84.2%) were positive for anti-CCP. Tests for RF were positive in 78.9% and 84.2% of patients with or without etanercept treatment, respectively. The serum levels of anti-CCP and RF decreased significantly after a three month etanercept treatment (p = 0.007 and p = 0.006, respectively). The average decrease from baseline calculated for each individual patient in the etanercept treated group was 31.3% for anti-CCP and 36% for RF. The variation in anti-CCP was positively correlated with the variation in disease activity, swollen and tender joint counts, RF, and C reactive protein. CONCLUSIONS: Etanercept combined with DMARDs leads to a much greater decrease than DMARDs alone in the serum levels of anti-CCP and RF in rheumatoid arthritis, compatible with a reduction in clinical disease activity.
18649049 Erythrocyte membrane gold levels after treatment with auranofin and sodium aurothiomalate. 2008 Winter Triethylphosphine gold-2,3,4,6-tetra-o-acetyl-L-thio-D-glucopyranoside (auranofin and sodium aurothiomalate; Myocrisin are two chemically different gold compounds used to treat rheumatoid arthritis. This study highlights the interaction, in vivo, of these drugs with erythrocyte membrane in patients with rheumatoid arthritis. Fifty-eight patients with definite or classical rheumatoid arthritis were included in this study and randomly allocated to three groups as 18 patients in the Myocrisin group, 20 patients in the auranofin group, and 20 patients in the placebo group. The drugs appeared to react, in vivo, in different ways. With Myocrisin, the level of gold in erythrocyte membrane was, initially, very high and decayed exponentially afterwards, whereas auranofin produced a constant high level up to 36 weeks. The erythrocyte membrane gold level in nonsmokers was higher than that in smokers in the auranofin group, and it decreased with an increase in the number of cigarettes smoked (r = 0.836 P < 0.01); no such correlation was observed in the Myocrisin group. In a changeover study, auranofin appeared to change the nature of erythrocyte membrane after reacting with it and rendering it incapable of picking up any gold from Myocrisin. In the case of auranofin, the hemolysate membrane gold level was found to correlate with clinical improvement.
18357860 [Prolactin response to stress in patients with systemic lupus erythematodes (SLE), rheumat 2007 Dec Prolactin is a one of the stress hormones, like the growth hormone, ACTH, cortisol and catecholamins. Among its wide range of functions is the important role of controlling the immune response which is, unlike in the case of cortisol, of stimulatory nature. For this activity, it is monitored as a factor influencing the progress and course of autoimmune diseases. The authors of the paper monitored prolactin response to stress in a normal stress situation, i.e. blood collection. A significant difference was detected between the levels of prolactin in 3 successive blood collections in 30 minute intervals (P < 0.001). Prolactin responded by a prompt increase in the serum level, followed by a relatively fast linear decrease. There was no difference in the response between the SLE and RA patient groups and the healthy population. Therefore we conclude that this is a normal reaction of the organism because acute response to stress in patients with autoimmune diseases is the same as in healthy persons.
17870548 [Frequency of cardiovascular risk factors and co-morbidity in patients with rheumatic dise 2006 Sep Analysis of national data from the health ministry programme of reduction of the cardiovascular risks (2002-2005) shows a high frequency of cardiovascular disease and cardiovascular risk factors in the general population. It is of interest to analyse these data in relation to the practice of rheumatology. In addition, the frequency of cardiovascular pathologies is higher in patients with rheumatoid arthritis and spondylarthropathy. These notions are also very important since these two populations are often treated with non-steroidal anti-inflammatory drugs for a long duration. General knowledge shown in this article concerning the cardiovascular risk factors and co-morbidities in the patients with rheumatic pathologies allows, within the context of a therapeutic decisional strategy in rheumatology, a better estimation of the individual benefit/risk ratio of each prescription and more particularly that of non-steroidal anti-inflammatory drugs.
17904711 Biomechanics of the foot in rheumatoid arthritis: identifying abnormal function and the fa 2008 Jan BACKGROUND: Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft-tissues of the foot and ankle. The aim of this study was to evaluate biomechanical foot function and determine factors associated with localised disease burden in patients with this disease. METHODS: Seventy-four rheumatoid arthritis patients (mean (standard deviation) age, 56 years (12); median (interquartile range) disease duration, 13 (5,19)) and 54 able-bodied adults (mean (standard deviation) age, 55 years (12)) completed the Leeds foot impact scale. Biomechanical foot function was measured using three-dimensional instrumented gait analysis. Disease activity score, the number of swollen and tender foot joints, and rearfoot and forefoot deformity were recorded. Sequential multiple linear regression was undertaken to identify independent predictors of foot disease burden. FINDINGS: The median (interquartile range) Leeds foot impact scale scores in the impairment and activity/participation subscales were 13 (10,14) and 17 (12,22) for the rheumatoid arthritis and 1 (0,3) and 0 (0,1) for the able-bodied adults, P<0.0001 both subscales. The patients had significantly higher numbers of swollen (P<0.0001) and tender foot joints (P<0.0001) and greater rearfoot (P<0.0001) and forefoot (P<0.0001) deformity. Rheumatoid arthritis patients walked slower (P<0.0001) and had altered biomechanical foot function. Sequential regression analysis revealed that when the effects of global disease activity and disease duration were statistically controlled for, foot pain, the number of swollen foot joints and walking speed, and foot pain and walking speed were able to predict disease burden on the Leeds foot impact scale impairment (P<0.0005) and Leeds foot impact scale activity/participation (P<0.0005) subscales, respectively. INTERPRETATION: In this cohort of rheumatoid arthritis patients, foot pain, swollen foot joint count and walking speed were identified as independent predictors of impairment and activity limitation and participation restriction. The foot disease burden model comprises important elements of pain, inflammatory and functional (biomechanical) factors.
16729012 Lupus anticoagulant and ischemic myocardial microangiopathy in rheumatoid arthritis. 2006 Jun BACKGROUND: A 49-year-old man presented at a hospital with an arthritic flare-up and stress dyspnea with a cough. He had a 5-year history of symmetrical polyarthritis, for which he was prescribed 5-15 mg prednisolone daily. He was subsequently diagnosed with rheumatoid arthritis and prescribed 20 mg methotrexate weekly, 3 mg/kg ciclosporin daily and 5 mg prednisolone daily. Infliximab therapy was initiated after 3 months because of persistent joint pain and inflammation. Six months later, however, the patient was readmitted to hospital with a new arthritic flare-up, acute retrosternal chest pain and stress dyspnea. INVESTIGATIONS: Laboratory analyses, electrocardiography, chest radiography, high-resolution CT, echocardiography, technetium-99m-labeled (99mTc)-methoxyisobutyl-isonitrile stress myocardial scintigraphy and coronary angiography. DIAGNOSIS: Lupus anticoagulant and ischemic myocardial microangiopathy. MANAGEMENT: Drug therapy with prednisolone, methotrexate, anakinra, aspirin and clopidogrel.
17680519 Interobserver agreement in two- and three-dimensional power Doppler sonographic assessment 2007 Aug PURPOSE: To compare the interobserver agreement in qualitative and quantitative two- (2D) and three-dimensional (3D) power Doppler ultrasonographic assessment of joint vascularity in wrist arthritis of patients with rheumatoid arthritis (RA) during anti-inflammatory therapy. MATERIALS AND METHODS: Tender and swollen wrists of 15 patients with RA were examined by two independent ultrasound investigators before and at day 3, 7, 14 and 42 after the initiation of an anti-inflammatory therapy. Besides the assessment of clinical and laboratory disease activity parameters, a linear array transducer was used to produce grey-scale images of synovitis and effusion as well as 2D and 3D power Doppler sonographic images and movies of synovial vascularity. Interobserver agreement was evaluated with regard to the obtained qualitative information such as grading of synovitis and Doppler signal intensity and compared with the correlations of quantitative assessments such as measurement of synovial thickening, resistance index (RI), 3D blood vessel count, computerized pixel count and first described computerized voxel count. RESULTS: High interobserver agreement was found for the measurement of synovial thickening (r = 0.86), the computerized voxel count (r = 0.85) and the 3D blood vessel count (r = 0.83) in contrast to significantly lower levels of agreement for RI measurement, the computerized pixel count, the grading of synovitis and the 2D and 3D Doppler grading. A significant decrease of synovial perfusion could be demonstrated by means of 2D and 3D Doppler ultrasound under the anti-inflammatory treatment in accordance with an improvement in clinical and laboratory disease activity. CONCLUSION: Quantification of 3D power Doppler images (voxel count) showed higher interobserver agreement compared with 2D quantitative analyses as well as with 2D and 3D semiquantitative grading, indicating this method as a reliable approach to measure synovial perfusion as sign of inflammatory activity in arthritis.
17143979 Role of insulin resistance in increased frequency of atherosclerosis detected by carotid u 2006 Dec OBJECTIVE: We evaluated the presence of subclinical atherosclerosis and factors influencing atherosclerosis, including insulin resistance (IR), in patients with rheumatoid arthritis (RA). METHODS: Sixty-three patients with RA and 34 controls were studied. Patients' cardiovascular risk factors were recorded; biochemical variables were determined. Intima-media thickness (IMT) of carotid arteries was determined by B-mode ultrasonography, and presence of atheromatous plaques was determined. IR was calculated according to the HOMA-IR homeostasis model. RESULTS: There were no differences in atherosclerotic risk factors between patients with RA and controls. In the RA group, the median carotid IMT was 0.61 mm (range 0.56-0.74), greater than the 0.54 mm (range 0.50-0.64) in controls (p = 0.01). There was a tendency to a higher frequency of carotid plaques in the RA group compared to controls [12 RA patients (19%) vs 2 controls (5.9%); p = 0.10]. Multivariate regression analysis revealed the factors that had an independent effect on increased carotid IMT: age (p < 0.001), male sex (p = 0.01), and total cholesterol level (p = 0.02). In RA patients with plaques, age (64.5 vs 48 yrs; p = 0.005), carotid IMT (0.75 vs 0.60 mm; p = 0.001), frequency of hypertension (58.3% vs 23.5%; p = 0.03), and IR (83.3% vs 29.4%; p = 0.001) were higher. Multivariate logistic regression analysis showed that factors independently associated with the presence of plaques were IR (OR 15.85, 95% CI 2.23-112.89, p = 0.006) and age (OR 1.11, 95% CI 1.02-1.21, p = 0.02). In RA patients, HOMA-IR correlated with age (r = 0.26, p = 0.04), Health Assessment Questionnaire score (r = 0.28, p = 0.04), and concentrations of triglyceride (r = 0.39, p = 0.003) and cholesterol (r = 0.33, p = 0.02). CONCLUSION: IR in the setting of active rheumatoid disease may contribute to mechanisms of accelerated atherogenesis observed in patients with RA.
17207388 The serum levels of resistin in rheumatoid arthritis patients. 2006 Nov OBJECTIVE: Adipocyte-derived resistin is a circulating protein implicated in insulin resistance, but the role of human resistin is uncertain because it is produced largely by macrophages. The aim of this study was to analyze serum resistin concentrations in rheumatoid arthritis (RA) patients to determine the role of resistin in human inflammatory diseases. MATERIALS AND METHODS: Resistin concentrations were assessed by ELISA in serum samples from 42 patients with RA. Serum samples from 38 healthy subjects acted as controls. We also evaluated the circulating levels of tumor necrosis factor- alpha (TNF-alpha) and disease activity markers in RA patients. RESULTS: In RA patients, serum resistin levels were significantly higher than those in healthy subjects. Serum resistin levels in RA patients were correlated with the RA disease activity markers, CRP and ESR. Furthermore, resistin levels in RA patients were significantly correlated with circulating levels of TNF-alpha. CONCLUSION: Serum resistin levels were significantly increased in RA patients and correlated with inflammatory markers and TNF-alpha, suggesting that resistin may play a role in the rheumatoid inflammatory process.
18564485 Reconstruction of severe uncontained bone defects in revision total knee arthroplasty in a 2008 Apr We report on a 54-year-old rheumatoid arthritic female patient with uncontained type-III tibial and femoral bone defects at the time of revision total knee arthroplasty (TKA). The knee was reconstructed using a structural distal femoral allograft and a stemmed, semi-constrained knee prosthesis. We achieved the re-alignment of a severe preoperative valgus deformity of 40 degrees. Due to postoperative wound complications we had to perform a gastrocnemius muscle flap. At two-year follow-up the patient was free of pain and the Knee Society Score improved from 18 to 156 (p < 0.01). Radiographs revealed no loosening of the prosthetic components and progressive incorporation of the graft. Reconstruction of extensive uncontained bone defects in revision of TKA in rheumatoid arthritis can be managed by structural allografts; however, wound complications in those patients might necessitate soft tissue techniques.
17951672 Acquisition, culture, and phenotyping of synovial fibroblasts. 2007 The study of fibroblast-like synoviocytes (FLS) has yielded important insights into the pathogenic mechanisms of rheumatoid arthritis. FLS can be cultured from synovial tissue obtained at joint replacement surgery, synovectomy, or synovial biopsy. After collagenase digestion, adherent cells consist mainly of synovial fibroblasts and synovial macrophages. Proliferating FLS are enriched by repeated passage and comprise >95% of cells by passage 3. Because of cell senescence, use of FLS lines after passage 9 is generally not recommended. FLS in culture have a distinct phenotype with regard to morphology, ultrastructure, surface phenotype, and function. Surface markers that can be used to characterize FLS include positive staining for VCAM-1, CD44, CD55, CD90 (Thy-1), and cadherin-11, coupled with the absence of macrophage markers such as CD14 or CD68.
17503048 Interferon gamma assay for detecting latent tuberculosis infection in rheumatoid arthritis 2007 Oct In rheumatoid arthritis (RA) patients treated with infliximab (IFX), QuantiFERON-TB Gold (QFT-G), an interferon gamma assay for diagnosing tuberculosis infection, was performed to compare its effectiveness to conventional diagnostic procedures (tuberculin skin test, imaging and medical history) in diagnosing latent tuberculosis infection (LTBI). QFT-G was measured bimonthly in 14 rheumatoid arthritis patients during IFX treatment. Seven of 14 patients were confirmed as LTBI positive by at least one method. Of these, four were positive on QFT-G during the study period, and two were positive before the start of IFX administration. For two of the four QFT-G-positive patients, LTBI was diagnosed only by QFT-G. The rate of agreement between QFT-G and conventional procedures was 64.3%. A total of 5% of QFT-G tests were impossible to judge due to decreased reactions in the positive control. These results suggest that QFT-G is able to detect LTBI in RA patients overlooked by conventional methods. Conventional procedures and QFT-G should be employed in parallel, and LTBI should be assumed when one technique gives a positive result.
16739845 [Clinical observation on needle-sticking method for treatment of rheumatoid arthritis of w 2006 May OBJECTIVE: To observe clinical therapeutic effect of needle-sticking method on rheumatoid arthritis (RA) of wind-cold-damp retention type. METHODS: Fifty cases of such disease were divided into 2 groups in order of visiting. The treatment group (n = 30) were treated with needle-sticking method, and the control group (n = 20) with routine filiform needle therapy for 2 therapeutic courses. Total cumulative scores, numbers of both the pressure-pain joint and the swollen-distention joint, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C reaction protein (CRP) before and after treatment were investigated. RESULTS: Both the needle-sticking method and the filiform needle therapy had an apparent therapeutic effect on RA of wind-cold-damp retention type, and the therapeutic effect for the clinical indexes in the treatment group was better than the control group, with a very significant difference in improvement of RF, the number of pressure-pain joints and the total cumulative scores as the treatment group compared with the control group (P < 0.01). CONCLUSION: Needle-sticking method has definite therapeutic effect on RA of wind-cold-damp retention type with obvious superiority.
17139640 Using internet technology to deliver a home-based physical activity intervention for patie 2006 Dec 15 OBJECTIVE: To compare the effectiveness of 2 Internet-based physical activity interventions for patients with rheumatoid arthritis (RA). METHODS: A total of 160 physically inactive patients with RA who had a computer with Internet access were randomly assigned to an Internet-based physical activity program with individual guidance, a bicycle ergometer, and group contacts (individualized training [IT] group; n = 82) or to an Internet-based program providing only general information on exercises and physical activity (general training [GT] group; n = 78). Outcome measures included quantity of physical activity (questionnaire and activity monitor), functional ability, quality of life, and disease activity (baseline, 3, 6, 9, and 12 months). RESULTS: The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 (38% versus 22%) and 9 months (35% versus 11%; both P < 0.05) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week, and at 6 (35% versus 13%), 9 (40% versus 14%), and 12 months (34% versus 10%; all P < 0.005) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week. In general, there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor, functional ability, quality of life, or disease activity. CONCLUSION: An Internet-based physical activity intervention with individually tailored supervision, exercise equipment, and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet-based program without these additional elements in patients with RA. No differences were found regarding the total amount of physical activity measured with an activity monitor.
17083756 What should be our treatment goal in rheumatoid arthritis today? 2006 Nov Remission should be the treatment aim in management of rheumatoid arthritis (RA) today because joint damage may progress in RA patients with low disease activity but presumably does not progress in patients in clinical remission. However, stringent criteria are needed to define remission status, as some criteria in current use allow for considerable residual disease activity. Even using stringent criteria, remission is achievable in a sizable proportion of patients in clinical trials and practice. Defining remission requires an additional consideration: Should a patient who is receiving medication be regarded as in remission if disease is absent, or must the patient be off treatment to be considered to be in remission? A case is made for aiming for a definition of remission that includes patients who continue medication therapy.
18662929 Hyperlipidaemia, statin use and the risk of developing rheumatoid arthritis. 2009 Apr OBJECTIVE: To evaluate whether statins are associated with a protective effect on the development of rheumatoid arthritis (RA). METHODS: A nested case-control study was conducted using data from the General Practice Research Database. A study population consisting of three groups of subjects aged 40-89 years was identified: (1) patients exposed to a statin or other lipid-lowering agent (LLA); (2) patients with a diagnosis of hyperlipidaemia in the absence of lipid-lowering drug treatment and (3) a random sample of 25 000 individuals with no diagnosis of hyperlipidaemia nor a prescription for a LLA. From this population incident cases of RA and up to four controls for each case were identified, matched on age, sex, general practice, number of years of recorded history in the database and index date. The independent effects of hyperlipidaemia and statins on the development of RA were evaluated using conditional logistic regression. RESULTS: 313 cases of RA and 1252 matched controls were identified. Compared with patients with untreated hyperlipidaemia, or hyperlipidaemia treated with LLA other than statins, the adjusted odds ratio for patients with no hyperlipidaemia was 0.68 (95% CI 0.50 to 0.91). When those with hyperlipidaemia who received statins were compared with those with hyperlipidaemia who did not use statins (ie, untreated hyperlipidaemia patients or those treated with non-statin LLA) the OR was 0.59 (95% CI 0.37 to 0.96). CONCLUSION: These data provide evidence to support the hypothesis that statins may be protective against the development of RA in patients with hyperlipidaemia.
16461068 Measuring process of arthritis care: the Arthritis Foundation's quality indicator set for 2006 Feb OBJECTIVE: To describe the scientific evidence that supports each of the explicit process measures in the Arthritis Foundation's Quality Indicator Set for Rheumatoid Arthritis. METHODS: For each of the 27 measures in the Arthritis Foundation's Quality Indicator set, a comprehensive literature review was performed for evidence that linked the process of care defined in the indicator with relevant clinical outcomes and to summarize practice guidelines relevant to the indicators. RESULTS: Over 7500 titles were identified and reviewed. For each of the indicators the scientific evidence to support or refute the quality indicator was summarized. We found direct evidence that supported a process-outcome link for 15 of the indicators, an indirect link for 7 of the indicators, and no evidence to support or refute a link for 5. The processes of care described in the indicators for which no supporting/refuting data were found have been assumed to be so essential to care that clinical trails assessing their importance have not, and probably never will be, performed. The process of care described in all but 2 of the indicators is recommended in 1 or more practice guidelines. CONCLUSION: There are sufficient scientific evidence and expert consensus to support the Arthritis Foundation's Quality Indicator Set for Rheumatoid Arthritis, which defines a minimal standard of care that can be used to assess health care quality for patients with rheumatoid arthritis.
18235538 Synoviolin, protein folding and the maintenance of joint homeostasis. 2008 Feb Rheumatoid arthritis is a disease associated with painful joints that affects approximately 1% of the population worldwide, and for which no specific cure is available. Among other functions, the endoplasmic reticulum (ER) has an important role in protein folding. When the level of unfolded proteins in the ER exceeds the folding capacity of this organelle, defective proteins are eliminated by ER-associated degradation (ERAD), an ATP-dependent ubiquitin-proteasome degradation process, to reduce the burden on the ER. Synoviolin is an E3 ubiquitin ligase that is involved in ERAD. This protein is a pathogenic factor for arthropathy; it is overexpressed in the synovial cells of patients with rheumatoid arthritis. This overexpression results in a 'hyper-ERAD' state, in which the cell deals with accumulated unfolded proteins excessively. Rheumatoid synovial cells produce large amounts of various proteins such as cytokines and proteases, which consequently might confer an autonomous proliferation property on the cells. At least 30% of all newly synthesized, ER-sorted proteins are unfolded. Although degradation of unfolded proteins consumes large amounts of ATP and would seem an unconventional process, it is essential for joint homeostasis.
16891218 Bacterial extract (OM-89) specific and non specific immunomodulation in rheumatoid arthrit 2006 Jun The Escherichia Coli bacterial extract (OM-89) is used in the treatment of rheumatoid arthritis (RA). We evaluated the immunological changes induced by oral administration of OM-89 in 12 RA patients (polyclonal T cell reactivity to PHA, T cell precursor frequencies specific for OM-89 and Tetanus toxoid (TT), a control antigen and the release of Th1 (IFN-gamma, TNF-alpha), Th2 (IL-4) and T regulatory 1 cell (Tr1) (IL-10) cytokines in the supernatants of PBMC cultures. Stimulation index in response to PHA decreased at month 3 as well as T cell precursor frequencies specific for TT with similar trends for OM-89-specific T cell precursor frequencies. OM-89 induced a strong production of IL-10, a significant decrease in IL-4 production while TNF-alpha and IFN-gamma production tended to decrease during the study. Our results suggest that OM-89 has immunomodulatory properties by inducing changes in PBMC cytokines release suggestive of an induced Tr1 response to OM-89.
16881107 Two distinct clinical courses of renal involvement in rheumatoid patients with AA amyloido 2006 Aug OBJECTIVE: We conducted a prospective study to investigate whether a correlation exists between the clinical course of renal involvement and the pathological findings of renal amyloidosis in patients with rheumatoid arthritis (RA). METHODS: Patients with RA of more than 5 years' duration and who did not show renal manifestations were selected and received a duodenal biopsy for the diagnosis of amyloidosis. After the diagnosis of AA amyloidosis, patients received a renal biopsy, and patterns of amyloid deposition were examined. We followed the renal functions (serum levels of blood urea nitrogen and creatinine) of patients diagnosed with AA amyloidosis for 5 years. RESULTS: We diagnosed 53 patients with AA amyloidosis and monitored the renal function of 38 of them for > 5 years. The histological patterns were examined; in the 38 patients there were appreciable variations in the patterns of amyloid deposition. In 27 patients, amyloid deposits were found exclusively in the glomerulus (type 1). In the other 11 patients, however, amyloid deposits were found selectively around blood vessels and were totally absent in the glomerulus (type 2). In type 1 patients with glomerular involvement, renal function deteriorated rapidly regardless of disease state; most patients received hemodialysis. In type 2 patients with purely vascular involvement, however, renal function did not deteriorate significantly. CONCLUSION: In patients with RA and AA amyloidosis, 2 distinct clinical courses in terms of renal involvement were identified. It is suggested that renal function does not deteriorate when amyloid deposition is totally lacking in the glomerulus.