Introduction:
Amyloidosis is a condition characterized by the deposition of fibrillar protein aggregates in various tissues. AA Amyloidosis, in particular results from prolonged inflammation such as that seen in arthritis, inflammatory bowel disease and chronic infections. This case report is significant as it highlights a rare instance of AA Amyloidosis in patient with long-standing psoriasis, Acute Kidney Injury (AKI) and Coronary Artery Disease(CAD) adding to the limited literature on this association
Methods:
A 49-year-old male patient, who has had psoriasis for the past 20 years, was recently started on Methotrexate 7.5mg/kg for Psoriatic arthritis. The patient developed pedal edema, and upon physical examination, the patient exhibited patches of hyperpigmentation on the skin, Onycholysis, and vertical ridges, indicative of chronic plaque psoriasis.
Results:
Laboratory finding showed elevated CRP(18mg/L), Serum Amyloid A (10.64mg/L) and creatinine(2.75mg/dL). A kidney biopsy revealed pale waxy eosinophilic deposits with apple green birefringence and amyloid deposits strongly positive for AA protein, confirming AA Amyloidosis. The patient was treated with secukinumab (300 mg subcutaneously weekly for five weeks), a first-line treatment for AA Amyloidosis with psoriasis. Laboratory and biopsy findings confirmed the diagnosis, consistent with the patient’s symptoms. A gradual decline is observed in creatinine(5.5-->3.67) and UPCR (1.17-->1.12) after 6 weeks of the treatment.
Conclusions:
These cases emphasize the need for early recognition and intervention in patients with psoriasis and psoriatic arthritis showing systemic involvement. It highlights the potential benefits of biologic therapies like secukinumab in preventing and managing severe complications such as AA Amyloidosis. This report contributes to the growing literature on the association between psoriatic arthritis and AA Amyloidosis, underscoring the need for further research to optimize treatment protocols.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.