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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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In this Article

• Amyloidosis facts
• What is amyloidosis?
• What causes amyloidosis?
• What are risk factors for amyloidosis?
• What are amyloidosis symptoms and signs?
• How is amyloidosis diagnosed?
• What is the treatment for amyloidosis?
• What are complications of amyloidosis?
• What is the prognosis of amyloidosis?
• Can amyloidosis be prevented?
• Patient Comments: Amyloidosis - Symptoms
• Amyloidosis Index

The diagnosis of amyloidosis is made by detecting the characteristic amyloid protein in a biopsy specimen of involved tissue (such as mouth, rectum, fat, kidney, heart, or liver). A needle aspiration biopsy of fat just under the skin of the belly (fat pad aspiration), originally developed at Boston University, offers a simple and less invasive method to diagnose systemic amyloidosis. Pathologists can see the protein in the biopsy specimen when it is coated with a special dye, called Congo red stain.

Initial treatment of amyloidosis involves correcting organ failure and treating any underlying illness (such as myeloma, infection, or inflammation). The disease is frequently discovered after significant organ damage has already occurred. Therefore, stabilization of organ function is an initial target of treatment. The most frequent cause of death in systemic amyloidosis is kidney failure.

Treatment includes chemotherapy agents usually used for certain cancers and dexamethasone for its anti-inflammatory actions.

Sephardic Jews and Turks inherit a genetic disease called familial Mediterranean fever, which is associated with amyloidosis and characterized by episodes of "attacks" of fever, joint, and abdominal pains. These attacks can be prevented with the medication colchicine. Armenians and Ashkenazi Jews also have a higher incidence of familial Mediterranean fever attacks but do not suffer amyloid deposition disease. Other reports of amyloidosis in families are extremely rare.

Researchers are currently enrolling patients with primary amyloidosis in clinical trials using a cancer chemotherapy medication (melphalan [Alkeran]) in conjunction with bone-marrow stem-cell transplantation. The results have been promising, and this combination treatment is offered to eradicate the amyloidosis in selected patients, provided that the underlying medical condition of the patient is adequate. These aggressive treatment options with stem-cell transplantation and high doses of chemotherapy are a true breakthrough in the treatment of patients with amyloidosis.

Familial ATTR amyloidosis can now be cured with liver transplantation. This option requires an accurate diagnosis of the specific protein that causes the disease.