Systemic amyloidosis and sacroiliitis in a patient with systemic lupus erythematosus

Abstract

We report a case of a 25-year-old female with juvenile onset systemic lupus erythematosus who developed systemic secondary amyloidosis with renal and gastrointestinal involvement. She has also had radiological signs of bilateral asymptomatic sacroiliitis without lower back pain or HLA-B27 antigen.

Tendinous and Ligamentous Derangements in Systemic Lupus Erythematosus

“…The musculoskeletal system is involved in nearly all patients with systemic lupus erythematosus (SLE), including arthralgias and arthritis as the most frequent manifestations. However, diverse tendon and ligament derangements have been sporadically reported as manifestations of SLE since 1975; these manifestations include tendinous laxity [1][2][3] , spontaneous tendon rupture 4,5 , Jaccoud's arthropathy 6,7 , atlantoaxial subluxation 1 , osteitis pubis 8 , and radiographic sacroiliitis [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . Recent studies using powerful imaging techniques such as magnetic resonance imaging (MRI), highresolution ultrasonography, and power Doppler have demonstrated inflammatory pathology in the tendons of these patients [23][24][25] .…”

“…However, in several cases it was not clear if the tendons or ligamentous derangements were part of the SLE manifestations or comorbid conditions. For instance, radiological sacroiliitis has been described in case reports or case series of highly selected SLE patients [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] ; some reports selected male SLE patients, some were associated with seronegative spondyloarthritis and others as part of SLE manifestations; there are, however, no studies of the frequency of sacroiliitis in consecutive SLE patients lacking other comorbidities. Sacroiliitis may also be found in infections and noninfectious diseases such as acne conglobata, familial Mediterranean fever, polymyalgia rheumatica, hyperparathyroidism, osteoarthritis, and even in seropositive rheumatoid arthritis 26,27 .…”

Les autres causes de sacro-iliites que les spondylarthropathies

“…L'observation de Kohli et Bennett [43] n'est pas assez détaillée, pour permettre la distinction entre une SpA HLA B27 négative associée au LES d'une atteinte SI sans autre explication que le LES. Un cas de sacro-iliite bilatérale asymptomatique a été rapporté chez une jeune femme HLA B27 négative ayant souffert d'un LES à début juvénile compliqué d'une amylose secondaire systémique [44].…”

Clinical Presentation of Amyloid A Amyloidosis

“…In other chronic rheumatic inflammatory diseases including systemic lupus erythematosus, polymyalgia rheumatica and Behçet's disease, AA amyloidosis has been rarely reported in case reports (52)(53)(54)(55)(56)(57)(58)(59). The development of AA amyloidosis was reported in 28 SLE patients (one of them overlapping with systemic sclerosis) between 1956-2011 (up to March, based on Pubmed).…”

“…The development of AA amyloidosis was reported in 28 SLE patients (one of them overlapping with systemic sclerosis) between 1956-2011 (up to March, based on Pubmed). The lack of acute phase response in SLE compared to other inflammatory diseases has contributed to reduce the incidence (52)(53)(54). Most of patients presented proteinuria/nephrotic-range proteinuria or nephrotic syndrome or progressive renal insufficiency when the amyloidosis was diagnosed.…”