Amyloidosis in rheumatoid arthritis: role of serum amyloid A gene (SAA1) polymorphism and Chlamydia trachomatis infection in the Belarusian patient population
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Submission date: 2013-03-26
Final revision date: 2013-10-21
Acceptance date: 2013-10-24
Online publication date: 2013-12-24
Publication date: 2013-12-20
Reumatologia 2013;51(6):409–414
Objective: Amyloidosis is an important severe complication of rheumatoid arthritis (RA). The study was designed to evaluate polymorphism of the gene encoding serum amyloid A as well as Chlamydia trachomatis infection as risk factors of development of amyloidosis in RA patients.
Material and methods : One-hundred and four patients with definite RA were investigated. The patients were divided into two groups, the AA-positive group (secondary amyloidosis confirmed by histopathological evaluation of the tissue sample) (45 patients), and the AA-negative group (59 patients).
The polymorphism of SAA1 and occurrence of Chlamydia trachomatis infection were assayed in all the patients.
Results: No significant differences between the two patient groups in the -13T/C allele frequency were revealed. Therefore, the -13T allele is not obligatory for AA amyloidosis development in Belarusian patients with RA. Comparison of groups for genotype and three allele frequencies showed statistically significant differences. The most notable differences were observed in SAA1 α/α genotype –c2 = 31.1 (p < 0.001). Forty-three of 45 AA-positive RA patients (96%) had SAA1 a/a genotype while only 32% AA-negative RA patients presented this genotype. A similar tendency was observed for allele a frequency: c2 = 47.01 (p < 0.001).
Up to 84% of 45 AA-positive RA patients had concomitant Chlamydia trachomatis infection during the course of RA. In the
AA-negative group association of RA and the infection was revealed in 10 (17%) of 59 patients only (p < 0.004).
The odds ratio (OR) calculated for the SAA1 a/a genotype was 45.26, and the 95% confidence interval (95% CI) was 9.9–206.8. Odds ratio for Chlamydia trachomatis infection was 26.6 (95% CI: 9.26–76.37).
Conclusion: Risk of secondary amyloidosis in RA patients significantly depends on SAA1 genotype and the presence of Chlamydia trachomatis infection.
Hazenberg BP, van Rijswijk MH. Where has secondary amyloid gone? Ann Rheum Dis 2000; 59: 577-579.
Sanmartí R, Gómez-Casanovas E, Solé M, et al. Prevalence of silent amyloidosis in rheumatoid arthritis and its clinical significance. J Rheumatol 2004; 31: 1013-1014.
Kucharz EJ. Amyloidoses. In: Internal medicine. Januszewicz W, Kokot F (eds.). Wydawnictwo Lekarskie PZWL, Warsaw 2006, vol. 3: 1396-1401 (in Polish).
Bergesio F, Ciciani AM, Santostefano M, et al. Renal involvement in systemic amyloidosis – an Italian retrospective study on epidemiological and clinical data at diagnosis. Nephrol Dial Transplant 2007; 22: 1608-1618.
Hazenberg BP, van Gameren II, Bijzet J, et al. Diagnostic and therapeutic approach of systemic amyloidosis. Neth J Med 2004; 62: 121-128.
Okuda Y, Takasugi K. Diagnostic and prognostic study of secondary amyloidosis complicating rheumatoid arthritis. Amyloid and Amyloidosis. Parthenon Publishing Group, New York 1998: 426-428.
Cunnane G, Grehan S, Geoghegan S, et al. Serum amyloid A in the assessment of early inflammatory arthritis. J Rheumatol 2000; 27: 58-63.
Kuroda T, Tanabe N, Harada T, et al. Long-term mortality outcome in patients with reactive amyloidosis associated with rheumatoid arthritis. Clin Rheumatol 2005; 25: 1-8.
Baba S, Masago SA, Takahashi T, et al. A novel allelic variant of serum amyloid A, SAA1g: genomic evidence, evaluation, frequency, and implication as a risk factor or reactive systemic AA-amyloidosis. Hum Mol Genet 1995; 4: 1083-1087.
Moriguchi M, Terai C, Kaneko H, et al. A novel single-nucleotide polymorphism at the 5’-flanking region of SAA1 associated with risk of type AA amyloidosis secondary to rheumatoid arthritis. Arthritis Rheum 2001; 44: 1266-1272.
Mavragani CP, Yiannakouris N, Zintzaras E, et al. Analysis of SAA1 gene polymorphisms in the Greek population: rheumatoid arthritis and FMF patients relative to normal controls. Amyloid 2007; 14: 271-275.
Soroka NF. Rheumatoid arthritis associated with chlamydial infection. Zdravoohranenie 2009; 1: 4-9 (in Russian).
Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324.
Ajiro J, Narita I, Sato F, et al. SAA1 gene polymorphisms and the risk of AA amyloidosis in Japanese patients with rheumatoid arthritis. Mod Rheumatol 2006; 16: 294-299.
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