Amyloidosis
Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weight loss, shortness of breath, palpitations, and feeling faint with standing. In AL amyloidosis, specific indicators can include enlargement of the tongue and periorbital purpura. In wild-type ATTR amyloidosis, non-cardiac symptoms include: bilateral carpal tunnel syndrome, lumbar spinal stenosis, biceps tendon rupture, small fiber neuropathy, and autonomic dysfunction.
| Amyloidosis | |
|---|---|
| Classic facial features of AL amyloidosis with bleeding under the skin (bruising) around the eyes | |
| Specialty | Internal Medicine |
| Symptoms | Feeling tired, weight loss, swelling of the legs, shortness of breath, bleeding, feeling light headed with standing |
| Usual onset | 55–65 years old |
| Causes | Genetic or acquired |
| Diagnostic method | Tissue biopsy |
| Treatment | Supportive care, directed at the underlying cause, dialysis, organ transplantation |
| Prognosis | Improved with treatment |
| Frequency | 3–13 per million per year (AL amyloidosis) |
| Deaths | 1 per 1,000 people (developed world) |
There are about 36 different types of amyloidosis, each due to a specific protein misfolding. Within these 36 proteins, 19 are grouped into localized forms, 14 are grouped as systemic forms, and three proteins can identify as either. These proteins can become irregular due to genetic effects, as well as through acquired environmental factors. The four most common types of systemic amyloidosis are light chain (AL), inflammation (AA), dialysis-related (Aβ2M), and hereditary and old age (ATTR and wild-type transthyretin amyloid).
Diagnosis may be suspected when protein is found in the urine, organ enlargement is present, or problems are found with multiple peripheral nerves and it is unclear why. Diagnosis is confirmed by tissue biopsy. Due to the variable presentation, a diagnosis can often take some time to reach.
Treatment is geared towards decreasing the amount of the involved protein. This may sometimes be achieved by determining and treating the underlying cause. AL amyloidosis occurs in about 3–13 per million people per year and AA amyloidosis in about two per million people per year. The usual age of onset of these two types is 55 to 60 years old. Without treatment, life expectancy is between six months and four years. In the developed world about one per 1,000 deaths are from systemic amyloidosis. Amyloidosis has been described since at least 1639.