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Risk factors for AA amyloidosis in Germany.
[familial mediterranean fever]
Abstract
Objective
:
To
identify
risk
factors
for
serum
amyloid-
A
(
AA
)
amyloidosis
in
patients
living
in
Germany
.
Methods
:
Clinical
and
genetic
data
were
obtained
from
71
patients
with
AA
amyloidosis
.
SAA
1
genotypes
were
analyzed
in
231
individuals
.
Control
groups
comprised
45
patients
with
long
-standing
inflammatory
diseases
without
AA
amyloidosis
and
56
age-matched
patients
without
any
inflammatory
disease
.
Results
:
The
most
frequent
underlying
diseases
of
AA
amyloidosis
were
familial
Mediterranean
fever
(
FMF
)
(
n
 
=
 
24
,
34
%
)
and
inflammatory
rheumatic
diseases
(
n
 
=
 
30
,
42
%
)
.
Patients
without
any
known
underlying
disease
(
n
 
=
 
11
,
16
%
)
were
considered
as
having
idiopathic
AA
amyloidosis
.
Patients
with
FMF
were
significantly
younger
at
disease
onset
and
younger
at
diagnosis
of
AA
amyloidosis
compared
with
patients
with
rheumatic
diseases
.
Patients
with
idiopathic
AA
amyloidosis
were
older
than
patients
with
definite
rheumatic
diseases
.
Patients
with
FMF
and
high
penetrance
MEFV
gene
mutations
had
a
relative
risk
of
1
.
73
for
AA
amyloidosis
.
Patients
with
FMF
or
a
rheumatic
disease
and
the
SAA
1
α
/
α
genotype
had
a
relative
risk
of
4
.
86
and
2
.
53
,
respectively
,
for
developing
an
AA
amyloidosis
.
The
prevalence
of
this
risk
genotype
was
36
%
in
German
patients
without
an
inflammatory
disease
,
92
%
in
German
patients
with
AA
amyloidosis
and
100
%
in
German
patients
with
idiopathic
AA
amyloidosis
.
Conclusions
:
Risk
factors
for
AA
amyloidosis
are
the
presence
of
a
hereditary
autoinflammatory
or
chronic
rheumatic
disease
,
elevated
C-
reactive
protein
and
SAA
serum
levels
,
a
long
delay
of
a
sufficient
therapy
,
an
advanced
age
and
the
SAA
1
α
/
α
genotype
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated