po
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A 60-year-old woman has developed a crippling arthritis over the past 20 years. On physical examination the arthritis primarily involves her hands and feet, with marked joint deformities characterized by ulnar deviation and swan-neck deformities of her fingers. She has an irregular heart rate. Laboratory studies show that her rheumatoid factor titer is markedly elevated, but her antinuclear antibody test is negative. A rectal biopsy shows submucosal deposition of pink amorphous material that stains positively with Congo red. Which of the following precursor proteins most likely gave rise to these deposits?
A Serum amyloid-associated protein
B Lambda light chains
C Transthyretin
D Amyloid precursor protein
E Beta-2-microglobulin
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| doc179
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A
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| new_n_lost
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A Serum amyloid-associated protein
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| po
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 (A) CORRECT. She has rheumatoid arthritis, which is a chronic inflammatory condition that can be complicated by amyloidosis of the reactive systemic variety with SAA protein contributing to amyloid deposition in a variety of organs.
(B) Incorrect. Light chains are derived from monoclonal antibodies produced from plasma cells. Some of these patients have multiple myeloma.
(C) Incorrect. Transthyretin protein can be the precursor for amyloid in some familial forms of amyloidosis and in cardiac amyloidosis.
(D) Incorrect. APP is seen in the neuritic plaques in the cerebral cortex of persons with Alzheimer disease.
(E) Incorrect. Beta-2-microglobulin contributes to amyloid deposition in persons on chronic hemodialysis.
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