INTRACTABLE DIARRHEA ASSOCIATED WITH SECONDARY AMYLOIDOSIS IN RHEUMATOID-ARTHRITIS

Objective-To examine the clinical characteristics of intractable diarr hoea associated with secondary amyloidosis in rheumatoid arthritis (RA ). Methods-Of 179 RA patients with biopsy confirmed secondary amyloido sis, 24 cases (23 women and one man) with intractable diarrhoea lastin g for more than one month were retrospectively evaluated. Results-The mean (SD) duration of diarrhoea was 87 (64) days. Prodromal symptoms o f gastrointestinal dysfunction (n = 21) and impaired peristalsis (n = 16) were observed. Laboratory data showed hypoproteinaemia (4.7 (0.85) g/dl) caused by malabsorption or protein loss and high values of C re active protein (17.0 (9.3) mg/dl). Recurrence of intractable diarrhoea (n = 4) and transition from intractable diarrhoea to other gastrointe stinal problems of amyloidosis (ischaemic colitis (n = 2) and intestin al pseudo-obstruction (n = 4)) were observed. In 19 patients (25 episo des) the duration of intravenous hyperalimentation at remission (18 ep isodes) was 68 (52) days. Corticosteroid pulse therapy was administere d to 10 patients (11 times) and the time elapsed from the end of corti costeroid pulse therapy to the end of diarrhoea was 18 (14) days. One and five year survival rates after the onset of intractable diarrhoea were 73.4% and 38.9%. Seven of 13 patients (54%) had died as a result of infectious diseases. Conclusion-Intractable diarrhoea associated wi th secondary amyloidosis in RA is a serious clinical entity and the pr ognosis is poor. Although it is assumed that intravenous hyperalimenta tion treatment and corticosteroid pulse therapy are favourable regimen s for intractable diarrhoea, the patients should be monitored for poss ible infectious complications.