Departments of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Amyloidosis Center of Expertise, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Amyloid. 2020 Mar;27(1):1-12. doi: 10.1080/13506129.2019.1693359. Epub 2019 Nov 25.
From a clinical perspective, there is a need for a reliable and comprehensive list of diseases causing AA amyloidosis. This list could guide clinicians in the evaluation of patients with AA amyloidosis in whom an obvious cause is lacking. In this systematic review, a PubMed, Embase and Web of Science literature search were performed on causes of AA amyloidosis published in the last four decades. Initially, 4066 unique titles were identified, but only 795 full-text articles and letters were finally selected for analysis. Titles were excluded because of non-AA type of amyloidosis, language, no full-text publication or irrelevance. Hundred and fifty diseases were initially reported to be associated with the development of AA amyloidosis. The presence of AA amyloid was proven in 208 articles (26% of all) of which 140 (67%) showed a strong association with an underlying disease process. Disease associations were categorized and 48 were listed as strong, 19 as weak, 23 as unclear, and 60 as unlikely. Most newly described diseases are not really unexpected because they often cause longstanding inflammation. Based on the spectrum of identified causes, a pragmatic diagnostic approach is proposed for the AA amyloidosis patient in whom an obvious underlying disease is lacking.
从临床角度来看，我们需要一份可靠且全面的疾病列表，这些疾病能够导致 AA 淀粉样变性。这份列表可以为临床医生评估那些病因不明确的 AA 淀粉样变性患者提供指导。在这项系统评价中，我们对过去四十年中发表的关于 AA 淀粉样变性病因的 PubMed、Embase 和 Web of Science 文献进行了检索。最初，我们确定了 4066 个独特的标题，但最终只有 795 篇全文文章和信件被选中进行分析。标题被排除的原因是非 AA 型淀粉样变性、语言、没有全文发表或不相关。最初有 150 种疾病被报道与 AA 淀粉样变性的发展有关。在 208 篇（占所有文章的 26%）文章中证明存在 AA 淀粉样蛋白，其中 140 篇（67%）显示与潜在疾病过程有很强的关联。疾病关联进行了分类，其中 48 种被列为强关联，19 种为弱关联，23 种为不明确关联，60 种为不太可能关联。大多数新描述的疾病并非完全出乎意料，因为它们通常会引起长期的炎症。基于已确定病因的范围，我们提出了一种针对那些病因不明确的 AA 淀粉样变性患者的实用诊断方法。
