J Rheum Dis.  2012 Oct;19(5):280-284. 10.4078/jrd.2012.19.5.280.

Secondary Amyloidosis Development in a Patient with Juvenile Rheumatoid Arthritis on TNF-alpha Inhibitors Treatment

  • 1Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. juji@catholic.ac.kr


Secondary amyloidosis is one of the most serious complications in chronic inflammatory diseases such as rheumatoid arthritis. The extracellular deposit of aggregates of amyloid leads to target organ dysfunction. The mainstay treatment of secondary amyloidosis is the control of underlying disease activity. Many reports have reported that TNF-alpha inhibitors improve clinical outcomes. Here, we encountered a 34-year-old patient with juvenile rheumatoid arthritis who developed secondary amyloidosis despite treatment with TNF-alpha inhibitors. We present this case and include a review of the literature.


TNF-alpha inhibitor; Rheumatoid arthritis; Amyloidosis

MeSH Terms

Arthritis, Juvenile Rheumatoid
Arthritis, Rheumatoid
Tumor Necrosis Factor-alpha
Tumor Necrosis Factor-alpha


  • Figure 1 X-ray of sacroiliac joint. Partial fusion of both sacroiliac joints.

  • Figure 2 X-ray of knee both AP (stand). Uniform joint space narrowing and periarticular osteopenia.

  • Figure 3 (A) Esophagogastroduodenoscopy, (B) Colonoscopy. (A) Severe atropic change at body and pylorus of stomach, (B) Diffuse petechiae and inflammation and spontaneous bleeding.

  • Figure 4 Congo red with polarizing microscope (×100). Moderate chronic inflammation and marked glandular atrophy, as well as amorphous eosinophilic deposits suggestive of amyloidosis (birefringence of apple green color) at the stomach.

  • Figure 5 Transthoracic echocardiogram. Severe concentric left ventricular hypertrophy with systolic kissing phenomenon, infiltrative CMP due to fine ground glass appearance of myocardium of left ventricle.


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