Patients with reactive systemic amyloidosis have a reduced ability to degrade amyloid A protein fibrils in vitro. The amyloid A degrading activity in serum has been attributed to a neutral serine protease or proteases. Our results show that patients with reactive systemic (amyloid A) amyloidosis have low activities of two serum esterases, namely, arylesterase and paraoxonase, whereas the activity of a third esterase, cholinesterase, is normal. The combination of reduced arylesterase (less than 55 kU/L) plus reduced paraoxonase activity (less than 35 U/L) was found in 32% of patients with rheumatoid arthritis complicated by amyloidosis, but in only 5% of a control nonamyloid patient group, including patients with rheumatoid arthritis, liver disease, and hypoalbuminemia (p less than 0.001). A significant correlation between serum arylesterase and amyloid A degrading activity was found (patients with rheumatoid arthritis plus amyloidosis, n = 31, r = 0.51, p less than 0.01; all patients, n = 95, r = 0.34, p less than 0.001). Our results suggest that the amyloid A degrading activity may be closely related to the esterase activity in serum.