Secondary amyloidosis medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.


OR
==Medical Therapy==


Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
* Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.
* Aggressively treating the disease that is causing the excess [[amyloid]] protein can improve [[symptoms]] and slow down or halt the progression of the disease.
* Complications such as [[heart failure]], [[renal failure]], and other problems can sometimes be treated, when needed.
*Although the choice of therapy depends on the underlying cause of chronic inflammation, the aim is always to suppress production of SAA to within the normal range.
*Examples of treatments for the commonest disorders underlying AA amyloidosis:<ref name="pmid30274625">{{cite journal| author=Papa R, Lachmann HJ| title=Secondary, AA, Amyloidosis. | journal=Rheum Dis Clin North Am | year= 2018 | volume= 44 | issue= 4 | pages= 585-603 | pmid=30274625 | doi=10.1016/j.rdc.2018.06.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30274625  }} </ref>


OR
{|
| valign="top" |
|+
! style="background: #4479BA;" |{{fontcolor|#FFF|Underlying Condition}}
! style="background: #4479BA;" |{{fontcolor|#FFF|Treatment Options}}
! style="background: #4479BA;" |{{fontcolor|#FFF|Examples}}
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |Inflammatory arthritis
| style="padding: 5px 5px; background: #F5F5F5;" | Conventional disease-modifying agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Gold
*Hydroxychloroquine sulfasalazine
*Azathioprine
*Methotrexate
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Other immunosuppressant agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cyclosporine
*Cyclophosphamide
*Mycophenolate
*Leflunomide
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Infliximab
*Etanercept
*Adalimumab
*Tocilizumab
*Rituximab
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |Periodic fevers
| style="padding: 5px 5px; background: #F5F5F5;" | On-demand agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Nonsteroidal anti-inflammatory drugs
*Prednisone
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Colchicine (for familial mediterranean fever)
| style="padding: 5px 5px; background: #F5F5F5;" |
Colchicine
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Anakinra
*Canakinumab
|-
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Inflammatory bowel disease
| style="padding: 5px 5px; background: #F5F5F5;" | Conventional disease-modifying agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Sulfasalazine
*Mesalazine
*Azathioprine
*Methotrexate
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Infliximab
*Adalimumab
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" |
*Metronidazole
*Ciprofloxacin
*Azithromycin
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
*Infliximab
*Adalimumab
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Surgery
| style="padding: 5px 5px; background: #F5F5F5;" |
ileo-cecal resection and primary reconstruction
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Immunodeficiency
| style="padding: 5px 5px; background: #F5F5F5;" | Immunoglobulins
| style="padding: 5px 5px; background: #F5F5F5;" |
*
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cotrimoxazole
*Miconazole
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Chronic infections
| style="padding: 5px 5px; background: #F5F5F5;" | Antibiotics and surgery
| style="padding: 5px 5px; background: #F5F5F5;" |
*
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Physiotherapy (in case of bronchiectasis)
| style="padding: 5px 5px; background: #F5F5F5;" |
*
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Immunodeficiency
| style="padding: 5px 5px; background: #F5F5F5;" | Immunoglobulins
| style="padding: 5px 5px; background: #F5F5F5;" |
*
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cotrimoxazole
*Miconazole
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Neoplasia
| style="padding: 5px 5px; background: #F5F5F5;" | Chemotherapy and surgery
| style="padding: 5px 5px; background: #F5F5F5;" |
Varies according to type of cancer
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents (in Castleman disease)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Tocilizumab
|-
|}


The majority of cases of [disease name] are self-limited and require only supportive care.
* Long-term inflammatory control can be accompanied by gradual regression of amyloid deposits and improvement in renal function.
 
*Currently a second clinical trial is in progress in order to evaluate a targeted inhibitor molecule, Kiacta, in the management of secondary amyloidosis.
OR
*Novel therapies aimed at promoting clearance of existing amyloid deposits soon may be an effective treatment approach.
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].




Revision as of 01:50, 30 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.

Medical Therapy

  • Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.
  • Aggressively treating the disease that is causing the excess amyloid protein can improve symptoms and slow down or halt the progression of the disease.
  • Complications such as heart failure, renal failure, and other problems can sometimes be treated, when needed.
  • Although the choice of therapy depends on the underlying cause of chronic inflammation, the aim is always to suppress production of SAA to within the normal range.
  • Examples of treatments for the commonest disorders underlying AA amyloidosis:[1]
Underlying Condition Treatment Options Examples
Inflammatory arthritis Conventional disease-modifying agents
  • Gold
  • Hydroxychloroquine sulfasalazine
  • Azathioprine
  • Methotrexate

Other immunosuppressant agents

  • Cyclosporine
  • Cyclophosphamide
  • Mycophenolate
  • Leflunomide

Biologic agents

  • Infliximab
  • Etanercept
  • Adalimumab
  • Tocilizumab
  • Rituximab
Periodic fevers On-demand agents
  • Nonsteroidal anti-inflammatory drugs
  • Prednisone

Colchicine (for familial mediterranean fever)

Colchicine

Biologic agents

  • Anakinra
  • Canakinumab
Inflammatory bowel disease Conventional disease-modifying agents
  • Sulfasalazine
  • Mesalazine
  • Azathioprine
  • Methotrexate

Biologic agents

  • Infliximab
  • Adalimumab

Antibiotics

  • Metronidazole
  • Ciprofloxacin
  • Azithromycin

Biologic agents

  • Infliximab
  • Adalimumab

Surgery

ileo-cecal resection and primary reconstruction

Immunodeficiency Immunoglobulins

Antibiotics

  • Cotrimoxazole
  • Miconazole
Chronic infections Antibiotics and surgery

Physiotherapy (in case of bronchiectasis)

Immunodeficiency Immunoglobulins

Antibiotics

  • Cotrimoxazole
  • Miconazole
Neoplasia Chemotherapy and surgery

Varies according to type of cancer

Biologic agents (in Castleman disease)

  • Tocilizumab
  • Long-term inflammatory control can be accompanied by gradual regression of amyloid deposits and improvement in renal function.
  • Currently a second clinical trial is in progress in order to evaluate a targeted inhibitor molecule, Kiacta, in the management of secondary amyloidosis.
  • Novel therapies aimed at promoting clearance of existing amyloid deposits soon may be an effective treatment approach.


References

  1. ↑ Papa R, Lachmann HJ (2018). "Secondary, AA, Amyloidosis". Rheum Dis Clin North Am. 44 (4): 585–603. doi:10.1016/j.rdc.2018.06.004. PMID 30274625.

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