French practical guidelines for the diagnosis and management of AA amyloidosis.

Autor: Georgin-Lavialle S; Sorbonne University, Internal medicine department, Tenon hospital, National reference center for autoinflamamtory diseases and AA amylodiosis (CEREMAIA), 4 rue de la Chine, 75020 Paris, France. Electronic address: sophie.georgin-lavialle@aphp.fr., Savey L; Sorbonne University, Internal medicine department, Tenon hospital, National reference center for autoinflamamtory diseases and AA amylodiosis (CEREMAIA), 4 rue de la Chine, 75020 Paris, France., Buob D; Sorbonne University, department of pathology, Tenon hospital, Paris, France., Bastard JP; Biochemistry department, Henri-Mondor hospital, Créteil, France., Fellahi S; Sorbonne University, Nephrology department, Tenon hospital, Paris, France., Karras A; Paris centre university, Nephrology department, Georges Pompidou European hospital, Paris, France., Boffa JJ; Sorbonne University, Nephrology department, Tenon hospital, Paris, France., Grateau G; Sorbonne University, Internal medicine department, Tenon hospital, National reference center for autoinflamamtory diseases and AA amylodiosis (CEREMAIA), 4 rue de la Chine, 75020 Paris, France., Audard V, Bridoux F, Damade R, Deshayes S, Giurgea I, Granel B, Hachulla E, Hot A, Jaccard A, Knebelmann B, Marciano S, Pelcot F, Sarrabay G, Boursier G, Sellam J, Terre A, Bourguiba R
Jazyk: angličtina
Zdroj: La Revue de medecine interne [Rev Med Interne] 2023 Feb; Vol. 44 (2), pp. 62-71. Date of Electronic Publication: 2023 Jan 23.
DOI: 10.1016/j.revmed.2022.12.004
Abstrakt: AA amyloidosis is secondary to the deposit of excess insoluble Serum Amyloid A (SAA) protein fibrils. AA amyloidosis complicates chronic inflammatory diseases, especially chronic inflammatory rheumatisms such as rheumatoid arthritis and spondyloarthritis; chronic infections such as tuberculosis, bronchectasia, chronic inflammatory bowel diseases such as Crohn's disease; and auto-inflammatory diseases including familial Mediterranean fever. This work consists of the French guidelines for the diagnosis workup and treatment of AA amyloidosis. We estimate in France between 500 and 700 cases in the whole French population, affecting both men and women. The most frequent organ impaired is kidney which usually manifests by oedemas of the lower extremities, proteinuria, and/or renal failure. Patients are usually tired and can display digestive features anf thyroid goiter. The diagnosis of AA amyloidosis is based on detection of amyloid deposits on a biopsy using Congo Red staining with a characteristic green birefringence in polarized light. Immunohistochemical analysis with an antibody directed against Serum Amyloid A protein is essential to confirm the diagnosis of AA amyloidosis. Peripheral inflammatory biomarkers can be measured such as C Reactive protein and SAA. We propose an algorithm to guide the etiological diagnosis of AA amyloidosis. The treatement relies on the etiologic treatment of the undelying chronic inflammatory disease to decrease and/or normalize Serum Amyloid A protein concentration in order to stabilize amyloidosis. In case of renal failure, dialysis or even a kidney transplant can be porposed. Nowadays, there is currently no specific treatment for AA amyloidosis deposits which constitutes a therapeutic challenge for the future.
(Copyright © 2022 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
Databáze: MEDLINE
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