The most common manifestations of secondary (AA) amyloidosis are nephrotic range proteinuria and bowel involvement with diarrhea. AA may therefore be difficult to distinguish from AL.31 In the west, AA mostly occurs in the setting of chronic inflammatory conditions (such as poorly controlled rheumatoid arthritis or ankylosing spondylitis), or chronic infections (e.g., osteomyelitis).25 In the developing countries, AA is much more common as a complication of tuberculosis, leprosy, or malaria. In the Middle East, familial Mediterranean fever (FMF) is a common cause of AA. Although most patients do have an antecedent history of attacks of polyserositis, rash, or arthritis, there are genetic pedigrees of FMF, wherein AA can develop without antecedent symptoms.32
Was this article helpful?