MACROAMYLASEMIA - A POSSIBLE CAUSE OF UNEXPLAINED HYPERAMYLASEMIA IN RHEUMATOID-ARTHRITIS

Macroamylasemia is a benign acquired condition, characterized by a ser um amylase unusually large in molecular size that has been found to oc cur in apparently healthy humans as well as in a variety of diseases i ncluding liver disease, diabetes, cancer, malabsorption and autoimmune disorders. Most commonly macroamylasemia results from the formation o f immune complexes between amylase and immunoglobulins. We describe th e first case of an association between macroamylasemia/hyperamylasemia and rheumatoid arthritis characterized by the absence of immunoglobul ins, as amylase binding globulins, within the macroamylase complex. Fa ilure to identify macroamylase as the cause of unexplained but benign hyperamylasemia correctly, can lead to costly studies (e.g. ultrasonog raphy, computerized tomography) to rule out pancreatic disease, and co uld induce prescription of unnecessary elemental diets and replacement therapies, as reported in our patient.