Clinical and therapeutic aspects of AA amyloidosis

摘要: Approach to the management of AA amyloidosis complicating RA. (A) In case proteinuria or loss renal function a rectal biopsy subcutaneous fat is suitable screening method for detection amyloidosis. If in any doubt, try ascertain diagnosis by biopsy. Adequate staining with alkaline Congo red and preferably immunohistochemical anti-AA antibodies should be performed. Beware pathology other than even presence positive (B) A vigorous attempt control disease activity RA made order eliminate production SAA, an acute phase protein. The response treatment monitored serial measurements CRP SAA. (C) some vital organs evaluated: (a) endogenous creatinine clearance extent proteinuria; (b) electrocardiogram optional echocardiography; (c) thyroid adrenocortical function; (d) intestinal absorption tests; (e) optional--SAP scintigraphy turnover studies. (D) Attention given adequate supportive treatment: blood pressure control; intercurrent infections; corticosteroids during major surgical procedures; pay attention possible effect NSAID on function. (E) total failure uncontrollable proteinuria: consider possibility primary transplantation; otherwise regular haemodialysis indicated.