AA amyloidosis in inflammatory joint diseases: A systematic review
- CEREMAIA
- Jul 8
- 2 min read
Journal: Seminars in Arthritis and Rheumatism
First author: Binta Savadogo
Country of study: France — international systematic literature review
CEREMAIA Tenon author: Sophie Georgin-Lavialle
Reference: Savadogo B, Fahed H, Sellam J, Georgin-Lavialle S, Fautrel B, Mitrovic S. AA amyloidosis in inflammatory joint diseases: A systematic review. Seminars in Arthritis and Rheumatism. 2025;74:152762.
5 key points
AA amyloidosis can occur when inflammation remains high for a long time in some inflammatory joint diseases.
The kidneys are often the main organs affected, which may cause protein loss in the urine and reduced kidney function.
The review suggests that AA amyloidosis appears to have become less frequent in some diseases since the introduction of more effective treatments.
Treatments that control inflammation well, especially biologic therapies, may improve markers such as serum amyloid A and kidney function.
The authors highlight the lack of recent data and the need to better measure the current burden of this complication.
Introduction
AA amyloidosis is a complication of chronic inflammation. It occurs when an abnormal protein called amyloid builds up in organs, especially the kidneys, but sometimes also the digestive tract, liver or heart. It may complicate inflammatory joint diseases such as rheumatoid arthritis, spondyloarthritis, psoriatic arthritis or juvenile idiopathic arthritis. Because modern anti-inflammatory treatments have greatly improved, the authors wanted to know whether this complication has become less common.
Methods
The authors performed a systematic literature review. They searched several medical databases up to October 2024 for studies describing patients with biopsy-confirmed AA amyloidosis related to inflammatory joint disease. Included studies had to report at least 10 patients and provide information on frequency, mortality or evolution under treatment.
Results
In total, 33 studies were included, representing almost 14,000 patients with inflammatory joint diseases. The data were very heterogeneous, and most studies were old, published before 2010. In rheumatoid arthritis, reported AA amyloidosis prevalence ranged from 16.7% to 25.2% before 2010 and appeared to decrease to 0.7% after 2010. In ankylosing spondylitis, reported prevalence ranged from 6.1% to 8.5% before 2010 and from 1.1% to 1.3% after 2010. Immunomodulating treatments, especially biologic therapies, seemed to improve some markers of AA amyloidosis.
Discussion
These findings suggest that better control of inflammation may reduce the risk of AA amyloidosis or improve its course. However, the authors remain cautious because available studies are old, very different from one another and do not allow firm conclusions. The article also emphasizes the importance of monitoring chronic inflammation and kidney function in patients with inflammatory joint diseases.
Conclusion
AA amyloidosis now appears to be less frequent than in the past in some inflammatory joint diseases, probably thanks to more effective treatments. Recent, larger and better standardized studies are needed to better understand the current risk and improve prevention.
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