Clinicopathological conference. A case of early ankylosing spondylitis with fatal secondary amyloidosis.

The patient (Case No. 227423 ; P.M. 11926) was a man aged 21 at the time of his death in 1966.His first complaint was in 1956 when at the age of 11 years he developed occasional pain with sudden onset affecting the right knee, the ankles, hips, and back.Examination at another hospital was negative and his condition improved.Two years later he complained of pain in the right knee and the hip, which became worse at night, and a general physician put forward the possibility of Still's disease.The sedimentation rate was 78 mm./hr.In 1959 he was seen for the first time at Hammersmith Hospital following a history of attacks of fever and pain in the hips, back, thighs, and knees for about 10 months.Examination at the time showed slight limitation of movement of the left hip.There was good movement of the back, and no other joints were affected.The sedimentation rate was 50 mm./hr., and the Rose-Waaler test was negative.In the following year the right knee became swollen and the spleen palpable.The sedimentation rate was 68 mm./hr., and the haemoglobin level was 9.4 g./100 ml.He was treated with prednisone at a dose of 15 mg./day falling to 7.5 mg./day, but because of poor progress he was referred again and admitted to the M.R.C. Rheumatism Unit at Taplow in 1961.At that time there was pain and swelling affecting the right elbow, the knees, and the left foot.There was also some limita- tion of the movement of the right hip.Back movements were