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This involves treating the underlying condition, such as bone marrow abnormality (AL amyloidosis) or rheumatoid arthritis (AA amyloidosis), or otherwise suppressing the production of amyloid forming proteins (e.g. Amyloidosis. Please be in touch if you are interested in joining. A biopsy of abdominal fat just under the skin, known as a “fat pad biopsy,” is often the first location biopsied. The lower the SAA concentration, the slower the rate of new amyloid deposition. Secondary (AA) amyloidosis is treated by controlling the underlying disorder and with powerful anti-inflammatory medicines called steroids, which fight inflammation. Treatment that suppresses or eliminates the inflammation or infection also decreases the SAA protein. AA amyloidosis. Amyloidosis is a disease in which amyloid proteins are deposited and build up in vital organs. This may sometimes be achieved by determining and treating the underlying cause. Find out more. disease in which an abnormal protein called amyloid accumulates in body tissues and organs Hazenberg, M.D., Peter D. Gorevic, M.D., AL amyloidosis has some of the same early signs and symptoms as AA amyloidosis but is a more aggressive form of amyloidosis. Medscape Reference provides current and comprehensive information on medical treatment options for amyloidosis AA … After that, you may have: 1. Background: Amyloid A (AA) amyloidosis is a complication of chronic inflammatory conditions that develops when proteolytic fragments of serum amyloid A protein (SAA) are deposited in tissues as amyloid fibrils. The disease leads to rapid end‐stage renal failure and renal dialysis is often unable to prevent early death [].AA amyloidosis is rarely seen with improved treatment of chronic infectious diseases, and rheumatic disease is now a leading cause of AA amyloidosis []. AA amyloidosis (AA) is the most severe complication of TRAPS. PubMed 10. Secondary, AA, amyloidosis is a rare systemic complication that can develop in any long-term inflammatory disorder, and is characterized by the extracellular deposition of fibrils derived from serum amyloid A (SAA) protein. Usually, organs that are affected by this condition are kidneys, spleen, liver, heart, digestive tract, and nervous system. AA* Serum amyloid A Renal A Fib Mutant fibrinogen A alpha ... Eprodisate for the treatment of renal disease in AA amyloidosis., N Engl J Med, 2007, vol. It is important to control the chronic infection or inflammatory disease which is responsible for the amyloid. It is mandatory to procure user consent prior to running these cookies on your website. Removal of excess body fluid reduces ankle swelling and breathlessness. These images were obtained from a man with rheumatoid arthritis complicated by AA amyloidosis, whose disease entirely remitted (amyloid deposits shrank) following treatment with infliximab for the rheumatoid arthritis.Reproduced with permission from Curr Op Pharm 2006;6:214-220. Amyloidosis: A disease caused by a buildup of abnormally shaped proteins (amyloid proteins) in organs. Policy, Cleveland Clinic is a non-profit academic medical center. Written by Debra Payne, Wife and Caregiver . The disease often is difficult to recognize because of its broad range of manifestations and what often are vague symptoms. The usual age of onset of these two types is 55 to 60 years old. But over the past 10 years the outlook for patients with AA amyloidosis has brightened considerably. When SAA levels are reduced, formation of new amyloid deposits is slowed down and often halted completely. Skin involvement is rarely a feature of the disease. Definition. The major therapy in AA amyloidosis is treatment of the underlying inflammatory or infectious disease. Amyloid deposits may even be cleared away faster than they are produced. AA amyloidosis (previously known as secondary [AA] amyloidosis) is a disorder characterized by the extracellular tissue deposition of fibrils that are composed of fragments of and/or intact serum amyloid A protein (SAA), a hepatic acute phase reactant. Precise diagnosis is important because treatment varies greatly, depending on your specific condition.Your doctor is likely to start with a thorough medical history and physical exam. Sometimes referred to as secondary amyloidosis due to the underlying inflammatory disease, AA amyloidosis is more common in developing countries. We also use third-party cookies that help us analyze and understand how you use this website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Loop diuretics are the main therapeutic agents for management of volume overload. The principal aim in treatment of patients with AA amyloidosis is to switch off production of the amyloidogenic protein (serum amyloid A protein) by controlling the underlying disease process. AA amyloidosis can affect many organs, resulting in the following signs and symptoms: Signs and symptoms indicating the kidneys are affected include: Signs indicating the liver is affected include: Symptoms indicating the stomach or intestines are affected include: Symptoms indicating the heart is affected (uncommon) include: AA amyloidosis is suspected in patients who have chronic inflammatory or rheumatic disease and begin to show signs and symptoms. S… This can increase to over 2000 mg per liter during an acute phase response and a sustained overproduction of SAA is required for the creation of the AA deposits that define AA amyloidosis. For patients with AA amyloidosis of uncertain aetiology, anakinra was shown to be safe and effective . Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. In a healthy individual, the median plasma concentration of SAA is 3 mg per liter. Overview AA Amyloidosis is caused by the accumulation of Serum Amyloid A protein into amyloid fibrils causing organ dysfunction. All had established but uncontrolled RA with a persistently raised ESR. Pulmonary amyloidosis may be localised or part of systemic amyloidosis. Necessary cookies are absolutely essential for the website to function properly. It can be very helpful to meet with a dietician for precise and personalised dietary advice. This form rarely significantly affects the heart. For AA amyloidosis, treating the underlying chronic inflammatory condition is crucial to stop further amyloid deposits. For Familial Mediterranean Fever, the medication colchicine (Colcrys®, Mitigare®) is very effective as a preventative medication. Proteins: Large molecules that control the structure and function of the body’s tissues and organs. AA amyloidosis has also become far less common in developed countries such as the UK over the last 10 years. If the biopsy is positive, the tissue sample undergoes further testing to rule out another type of amyloidosis called AL amyloidosis. This may sometimes be achieved by determining and treating the underlying cause. Electrocardiography (EKG): A recording of the heart’s electrical activity. How is AA amyloidosis treated? This protein is produced by the body in response to inflammation or infection. If not effectively treated, AA amyloidosis leads inevitably to kidney failure, necessitating dialysis or kidney transplantation. But opting out of some of these cookies may have an effect on your browsing experience. We studied all patients presenting to our unit with AA amyloidosis over a 14‐year period to evaluate these aspects. In AA (historically known as secondary) amyloidosis, the treatment depends on the underlying disease. The disease often is difficult to recognize because of its broad range of manifestations and what often are vague symptoms. There are many good treatment options available for other conditions such as Crohn’s disease, ulcerative colitis, and rheumatoid arthritis. existing amyloid deposits often regress (become smaller), organ function is often preserved and may also recover, anakinra for some other periodic fever syndromes, such as, appropriate antibiotic drugs for tuberculosis, surgery for Castleman’s disease and osteomyelitis, carefully monitoring and maintenance of fluid balance, regular testing of kidney functions with blood and urine tests. AA (Inflammatory) Amyloidosis Treatment & Management Approach Considerations. In chronic inflammatory processes AA-amyloid can be deposited. Kidney transplantation may be successful and it is rare for AA amyloid to significantly affect a transplanted kidney. The kidney, liver and spleen are the organs are most affected in secondary systemic amyloidosis. METHODS: FMF patients with histologically proven AA amyloidosis, treated with TCZ (8 mg/kg per month) were followed monthly and the changes in creatinine, creatinine clearance, the amount of 24-hour urinary protein, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were noted throughout the treatment period. As the inflammation associated with these diseases is controlled with medication, the AA amyloidosis slowly regresses. Get useful, helpful and relevant health + wellness information. Continued monitoring of SAA levels is important even after therapy has led to adequate control of SAA levels. Valentine’s Day 2013, we received a call from my husband’s nephrologist. as long as patients are careful about taking their medicines as prescribed, Treatment of kidney disease in AA amyloidosis. We'll assume you're ok with this, but you can opt-out if you wish. AA amyloidosis is a form of amyloidosis, a disease characterized by the abnormal deposition of fibers of insoluble protein in the extracellular space of various tissues and organs.In AA amyloidosis, the deposited protein is serum amyloid A protein (SAA), an acute-phase protein which is normally soluble and whose plasma concentration is highest during inflammation. If the fat pad biopsy is negative, the next step is usually to biopsy the affected organ. Your care plan will also include treatment for symptoms and side effects. 1994 Dec. 37(12):1804-11. Both surgery and medication can be used to achieve successful treatment outcomes for patients. The National Kidney and Urologic Diseases Information Clearinghouse: National Organization for Rare Disorders. Light-chain (AL) amyloidosis is the most common form of systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. In FMF, colchicine is the treatment of choice and has been shown to alleviate the abdominal pain. Transthyretin: A protein produced by the liver. AA amyloidosis is managed by controlling the underlying inflammatory disease and therefore reducing the production of the amyloid protein SAA. Doctors at the NAC usually recommend monthly measurement of SAA levels in the blood in order to determine whether the treatment is controlling inflammation adequately. Patients visiting the NAC may be provided with a special kit for sending monthly blood samples in the post. Arthritis Rheum . Supporting the function of organs containing amyloid. This category only includes cookies that ensures basic functionalities and security features of the website. 2349-2360) Google Scholar. Atrial Fibrillation: An irregular heart rhythm. There may be sudden resurgences of inflammation even after a relatively long period of stable disease and improved kidney function. Our bodies make several proteins that can cause amyloidosis. In recent years the outlook for patients with AA amyloidosis has improved dramatically with the introduction of several new and effective drugs that control inflammation and lower SAA levels in the common chronic inflammatory diseases associated with AA amyloidosis such as rheumatoid arthritis and Crohn’s disease. Treatment which suppresses or eliminates the inflammation or infection also decreases the serum amyloid A (SAA) protein. Amyloid A (AA) amyloidosis is the third most common type of systemic amyloidosis in Australia. If the level is maintained close to normal (i.e. Several litres of fluid can accumulate in the body without it being very noticeable. Taking these drugs is not a substitute for avoidance of excessive dietary salt and water. Your blood and urine may be analyzed for abnormal protein that can indicate amyloidosis. This includes attention not just to salt added to the food from the salt shaker, but also to food with high salt content such as crisps, bacon, canned meats, sausages, canned soups and smoked fish. Treatment options and recommendations depend on several factors, including the type of amyloidosis, the type of underlying disease, possible side effects, and the patient’s preferences and overall health. A rapid and complete control of the inflammatory process is the main goal of treatment in patients with AA amyloidosis, and thus basically depends on the nature of the underlying condition. The Periodic Fever Service at the National Amyloidosis Centre, The inherited periodic fever syndromes – general information, The inherited fever syndromes – information on each syndrome, TNF receptor associated periodic syndrome (TRAPS), Mevalonate Kinase Deficiency (MKD), also known as Hyperimmunoglobulin D syndrome and periodic fever syndrome (HIDS), Cryopyrin-Associated Periodic Syndrome (CAPS), NALP12 associated periodic fever syndrome, Deficiency of the IL-1 receptor antagonist (DIRA), Pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, Auto-inflammatory diseases of unknown cause, Professor Sir Mark Pepys – interview and lecture, Treating systemic amyloidosis by removing amyloid deposits from the tissues and organs of the body: good news, bad news and hope for the future, Videos of National Amyloidosis Centre (NAC) staff. However, in a study conducted by Jung et al. This website uses cookies to improve your experience while you navigate through the website. Treatment of AA amyloidosis in rheumatoid arthritis. Treatment aims to slow amyloid protein production and reduce symptoms. SAA concentration should be strictly monitored over time to assess biochemical response to treatment. may reduce the production of amyloid A, with stabilization of the GI symptomatology. Relieving a person’s symptoms and side effects is an important part of care. This makes development of AA amyloidosis very unlikely as long as patients are careful about taking their medicines as prescribed. AL; AA; Hereditary ; Wild-type; Other; Search. Patients who have chronic rheumatological conditions such as SLE, rheumatoid arthritis, or chronic infections such as bronchiectasis, osteomyelitis or tuberculosis that are not controlled are at risk. AA amyloidosis occurs when Serum Protein A levels in the bloodstream remain high for a long period of time. This protein is produced by the body in response to inflammation or infection. 356 23 (pg. The drugs used are similar to those used in the related condition of multiple myeloma. Amyloidosis is often overlooked because the signs and symptoms can mimic those of more-common diseases. Methods. Treatment regimes are referred to as ‘chemotherapy’. These cookies will be stored in your browser only with your consent. Secondary, AA, amyloidosis is a rare systemic complication that can develop in any long-term inflammatory disorder, and is characterized by the extracellular deposition of fibrils derived from serum amyloid A (SAA) protein. Unfortunately there are no good trials to assist clinical practice. As amyloid fibrils build up in one or more tissues and organs, the cells can no longer work together and the organ(s) loses function. There is frequently regression of existing deposits if the SAA level is maintained close to normal (less than 10 mg per litre). Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were treated with chlorambucil. SAA results may be sent directly to patients to encourage their understanding of their progress and involvement in their own management. Despite the fact that AA amyloidosis is a well‐recognized complication of inflammatory diseases, there are few studies evaluating prognostic markers, natural history and treatment. Therapy for AA amyloidosis. So amyloidosis develops far less frequently than it did in the past. Colchicine has not been helpful for AA amyloidosis of other causes or for other amyloidoses. KEYWORDS. Advertising on our site helps support our mission. 50 22 (pg. Selvanayagam JB, Hawkins PN, Paul B, Myerson SG, Neubauer S. Evaluation and management of the cardiac amyloidosis., J Am Coll Cardiol, 2007, vol. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, AA Amyloidosis: Pathogenesis and Targeted Therapy, Systemic amyloidosis: novel therapies and role of biomarkers, Heart, Vascular & Thoracic Institute (Miller Family), Excessive bubbles in the urine (foamy/frothy urine), Increased level of protein in the urine (proteinuria), High cholesterol levels (hypercholesterolemia). Salt intake should be limited. The major therapy in AA amyloidosis is treatment of the underlying inflammatory or infectious disease. The treatment of AA amyloidosis is presented here. Find the latest information from the globally recognized leader in digestive diagnosis, treatments and surgical innovations. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs. We do not endorse non-Cleveland Clinic products or services. An increase in weight can be an early sign of fluid excess. Biopsy: A small piece of tissue that is removed and examined under a microscope. Eprodisate is a member of a new class of compounds designed to interfere with interactions between amyloidogenic proteins and glycosaminoglycans and thereby inhibit polymerization of amyloid fibrils and deposition of the fibrils in tissues. Today’s treatment plans are two-fold: Supportive treatment – treating your symptoms and organ damage; and, A recent report has indicated that eprodisate is a useful antifibril compound for treatment of AA amyloidosis, significantly delaying progression to HD or ESKD . Amyloid is an abnormal protein that is produced in your bone marrow and can be deposited in any tissue or organ.Amyloidosis can affect different organs in different people, and there are different types of amyloid. Light-chain (AL) amyloidosis is the most common form of systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. All patients with AA amyloidosis affecting their kidney function should be seen regularly by a nephrologist who is expert in amyloidosis. Some patients with amyloidosis are interested in organising local support group meetings. This is usually best done first thing in the morning after passing urine, just wearing underclothes. Amyloid Fibril: A rigid stack of amyloid proteins that builds up in the organs. Cleveland Clinic is a non-profit academic medical center. Eprodisate for the Treatment of Renal Disease in AA Amyloidosis List of authors. If not effectively treated, AA amyloidosis leads inevitably to kidney failure, necessitating dialysis or kidney transplantation. This can be seen in chronic (long-term) inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease, ulcerative colitis), and chronic infections. Amyloidosis frequently affects the heart, kidneys, liver, spleen, nervous system and digestive tract. It is also known as amyloid A (AA) amyloidosis and is the most common form of systemic amyloidosis worldwide. For familial Mediterranean fever, colchicine in a dose of 1.2-1.8 mg/day is the appropriate treatment. Sometimes it is necessary to try various different treatments before SAA levels are effectively controlled. The major therapy in AA amyloidosis is treatment of the underlying inflammatory or infectious disease. AL amyloidosis treatment is directed towards the abnormal plasma cells (usually in the bone marrow), producing abnormal light chains that form amyloid deposits. For familial Mediterranean fever, colchicine in a dose of 1.2-1.8 mg/day is the appropriate treatment. It is important to control the chronic infection or inflammatory disease which is responsible for the amyloid. SAA is an acute-phase reactant synthetized largely by hepatocytes under the transcriptional regulation of proinflammatory cytokines. Treatment is aimed at the underlying condition. Familial (hereditary) amyloidosis . Search ADS. Diagnosis as early as possible can help prevent further organ damage. Echocardiogram: An ultrasound of the heart to show how well it is working. If the tap is turned down sufficiently, the water can drain away slowly. Fluid excess can be avoided by careful attention to the 3 Ds: Fluid intake should be steady and should usually not exceed 1.5 litres per day. In contrast, in developing countries where these drugs are not widely available, AA amyloidosis remains more common. Important principles include: Abnormal kidney function due to AA amyloidosis may affect the ability of the kidneys to produce urine. In addition, colchicine is sometimes prescribed. If the tap is turned on fully so that the rate of running water far exceeds the drainage rate, water builds up in the basin despite some drainage. Amyloidosis is a “protein misfolding disorder.” Normally, proteins in the bloodstream are removed and/or recycled once they have completed their job. If AA amyloidosis is related to tuberculosis or FMF, treatment of these underlying diseases should also be started. Amyloid light-chain (AL) amyloidosis, also known as primary amyloidosis, is the most common form of systemic amyloidosis in the US. Improved treatments for severe inflammatory conditions have resulted in a sharp decline in the number of cases of AA amyloidosis in developed countries. The clinical syndromes at presentation include nephrotic-range proteinuria with or without renal dysfunction, hepatomegaly, … Patients with fluid overload may develop swelling in the legs (oedema) or difficulty breathing due to heart failure. A 47-year-old man with a medical history of smoking and chronic hidradenitis suppurativa (HS) presented to the emergency department complaining of asthenia, … Cardiac magnetic resonance imaging (MRI): A scan that creates detailed pictures of the heart and shows how well it is working. Occasionally low dose chemotherapy drugs may be used to suppress inflammation when other drugs fail. The aim of treatment in AA amyloidosis is to control the underlying inflammatory disease and thereby reduce the amount of SAA in the blood. Donate; Amyloidosis “Rock Star” Ralph Payne. There is then a good chance of improvement in organ function, overall health and length of survival. Medical or surgical treatment may be used to accomplish this. Cleveland Clinic Center for Personalized Genetic Healthcare, Cleveland Clinic Appointments: 866.320.4573. Sometimes the doctor will choose to start directly with a biopsy of the affected organ. When considering supplementary treatment, cardiac amyloidosis is a major therapeutic problem. When the inflammation is controlled by these drugs, patients are not exposed to prolonged high SAA levels. Water running from the tap at full blast represents the uncontrolled production and high level presence of precursor proteins capable of forming amyloid fibrils. For AA amyloidosis, treating the underlying chronic inflammatory condition is crucial to stop further amyloid deposits. Supporting amyloidosis patients and families while promoting research, education and awareness. The goal of secondary amyloidosis treatment is the suppression of the production of the SAA precursor protein, which is achieved by the treatment of chronic inflammation, including surgical treatment (sequestrectomy for osteomyelitis, removal of the lung lobe with bronchiectasis), tumor, tuberculosis. For Familial Mediterranean Fever, the medication colchicine (Colcrys®, Mitigare®) is very effective as a preventative medication. Treatment is geared towards decreasing the amount of the involved protein. Laura M. Dember, M.D., Philip N. Hawkins, F.Med.Sci., Bouke P.C. Biologic agents (anti-TNFα, anti-IL-1, anti-IL-6) can be used to reduce the risk and treat active AA amyloidosis related to autoimmune and rheumatic disorders. In some patients, kidney function improves once SAA levels are lowered, even if there is just stabilization of amyloid deposits. It is important that weight should be measured consistently- using the same scales, at the same time of day. Without treatment, this can lead to organ failure. Advertising on our site helps support our mission. Some patients benefit from recording their weight regularly, usually daily or weekly. The Glickman Urological & Kidney Institute offers innovative treatments in urology and nephrology, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease. Patients may sometimes be symptom free, despite on-going inflammation. Visit our online forum – a place where patients with amyloidosis, family, friends and carers from all over the UK can connect, communicate and help each other. Moderate (> 1 gm, < 3.5 gm/d) to nephrotic range (> 3.5 gm/d) proteinuria and a relatively well preserved renal function was noted in three patients. This buildup of proteins causes these organs to thicken and lose function. In AA amyloidosis, the goal of treatment is to control the associated inflammatory disease, leading to a damping down of the acute phase response and a subsequent drop in SAA levels. AA amyloidosis, also known as secondary amyloidosis, is a systemic amyloidosis syndrome triggered by long‐standing inflammatory activation. The build-up of amyloid proteins (deposits) can make it difficult for the organs and tissues to work properly. In two patients with AA amyloidosis … Laboratory tests. Crossref. Both surgery and medication can be used to achieve successful treatment outcomes for patients. It is important to introduce specific therapies for individual diseases in such cases. Reducing the supply of amyloid forming precursor proteins. The treatment is focused upon controlling the causative condition. AA amyloidosis. Colchicine treatment of AA amyloidosis of familial Mediterranean fever. (248) 922-9610. A rapid and complete control of the inflammatory process is the main goal of treatment in patients with AA amyloidosis, and thus basically depends on the nature of the underlying condition. AA amyloidosis is one of most severe complications of rheumatoid arthritis (RA). A biopsy (the removal of cells or tissue) is required to confirm AA amyloidosis. AA-amyloidosis is a systemic disorder with a precursor in blood, acute phase serum amyloid A (SAA). The experience with kidney transplantation in AA amyloidosis … SAP scintigraphy scan is usually recommended about once a year to quantify the amyloid deposits in the organs. 1-ranked heart program in the United States. Autoimmune (AA) amyloidosis: You can get this type after an infection like tuberculosis, or a disease that causes inflammation such as rheumatoid arthritis or inflammatory bowel disease. For familial Mediterranean fever, colchicine, 1.2 to 1.8 mg/day, is the appropriate treatment. The type of treatment is based upon disease progression and seriousness of the patient’s organ, tissue and nerve involvement. An analysis of factors affecting outcome. It is also seen in inherited periodic fever syndromes such as Familial Mediterranean Fever. AA amyloidosis, SAPHO syndrome, hidradenitis suppurativa CASE DESCRIPTION. AA (secondary) amyloidosis is characterized by a protein called "serum amyloid A." The small sink outlet represents the body’s limited capacity to clear amyloid deposits away from the organs. Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were … These drugs include new injectable, biological drugs for arthritis and Crohn’s disease, including: There are specific treatments for some inflammatory diseases which suppress the acute phase response and SAA levels very effectively. You also have the option to opt-out of these cookies. New therapies in the research and development stage include medications that bind and clear the amyloid fibril building blocks from the blood and antibodies that target and clear amyloid fibrils that have already been deposited. Livneh A, Zemer D, Langevitz P, et al. But over the past 10 years the outlook for patients with AA amyloidosis has brightened considerably. Whole body SAP scans showing amyloid in the liver and spleen (left panel) and significant amyloid regression between the initial scan and follow-up two years later (right panel). Amyloidosis is the name for a group of rare, serious conditions caused by a build-up of an abnormal protein called amyloid in organs and tissues throughout the body. Serum amyloid A protein occurs at high levels when inflammation (irritation and swelling) is present in the body. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. In AA amyloidosis, if the rate of production of amyloid forming proteins due to underlying inflammatory disease can be reduced sufficiently, amyloid stops accumulating in the tissues. AA amyloidosis is managed by controlling the underlying inflammatory disease and therefore reducing the production of the amyloid protein SAA. The cornerstone of management of AA amyloidosis is vigilance, timely recognition and sometimes aggressive immunosuppressive treatment. For familial Mediterranean fever, colchicine, 1.2 to 1.8 mg/day, is the appropriate treatment. AL amyloidosis occurs in about 3–13 per million people per year and AA amyloidosis in about 2 per million people per year.
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