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People with amyloidosis, a rare disease that develops when the body makes high levels of certain abnormal proteins, may also have other health conditions. There are a few types of amyloidosis, which can affect different parts of the body. Sometimes, amyloidosis occurs because of other health conditions, but it can also cause changes that lead to additional diseases.
When someone has more than one disease at the same time, the conditions are known as comorbidities. When an additional medical condition develops during an existing disease or following a treatment, it is known as a complication. In people with amyloidosis, having a comorbidity or complication can make treatment more difficult.
Having other health conditions in addition to amyloidosis can make it harder for your health care team to diagnose or treat your amyloidosis, and it may even influence your prognosis. Understanding how other health conditions are related to amyloidosis can help you talk to your doctor about treatment options. Addressing related conditions may improve your quality of life, prolong survival, and help you better manage your overall health.
Age plays a role in the risk for developing comorbidities. The longer a person lives, the more likely they are to be diagnosed with chronic health problems. Amyloidosis is more likely to occur in older adults. The most common form of this disease, amyloid light-chain (AL) amyloidosis, most often occurs in adults over the age of 60. Another type, wild-type ATTR amyloidosis, is typically diagnosed after the age of 70. Older adults with amyloidosis may be more likely to also have other health conditions.
AA amyloidosis is a type of amyloidosis that develops when other diseases cause ongoing inflammation. Inflammation is a healing process the body uses when it is injured or infected. However, when this process goes on for too long, it can cause damage. During the body’s inflammatory response, the liver makes a protein called serum amyloid A (SAA) protein. When inflammation lasts for a long time, pieces of SAA can form amyloid deposits in different organs, which can result in AA amyloidosis.
Several health conditions can cause inflammation and lead to amyloidosis. About 50 percent of people with AA amyloidosis have rheumatoid arthritis. Other types of arthritis can also lead to this condition, including juvenile arthritis, psoriatic arthritis, ankylosing spondylitis, and Reiter’s syndrome. Other underlying diseases that can be risk factors for developing amyloidosis include:
Amyloidosis is rare even for people who do have these inflammatory conditions. More than 19 out of 20 people who have one of these diseases will never develop AA amyloidosis. However, if you have a chronic infection or an immune condition, it may help to keep an eye out for signs and symptoms of AA amyloidosis. The first indications of amyloidosis often include signs of kidney damage, such as swelling in the legs or ankles (due to fluid retention) and high cholesterol levels.
If you have an inflammatory disease and develop amyloidosis, it is important to properly manage both conditions. One of the best ways to treat AA amyloidosis is to manage the underlying disease. Reducing inflammation through medication, treating infections with antibiotics, or managing tumors through surgery can help lower levels of SAA proteins.
When a person has kidney failure, also known as renal failure, the kidneys can’t properly carry out their tasks. This can lead to a specific type of amyloidosis. The kidneys are responsible for several important functions:
Kidney problems can cause waste and fluid to build up in the body, leading to swelling and less frequent urination. People with kidney failure may also have low levels of red blood cells, which causes tiredness, and they can develop hypertension (high blood pressure) or bone disease.
Kidney failure is often treated with dialysis, a procedure in which a machine is used to filter the blood. However, dialysis can’t effectively remove certain proteins, including a protein called beta-2 microglobulin. In some people undergoing this procedure, beta-2 microglobulin blood levels rise and form amyloids, leading to a condition called dialysis-related amyloidosis. This form of amyloidosis often leads to joint stiffness and pain, bone cysts, and carpal tunnel syndrome — a condition that can cause the wrists to become weak, numb, or painful.
Diagnosis of dialysis-related amyloidosis may include blood and urine tests to look for the presence of amyloid proteins, and imaging tests such as computed tomography (CT) scans or X-rays to look more closely at the bones and joints. People with this condition will have to manage their amyloidosis while also treating their kidney failure. Some symptoms, such as bone cysts and carpal tunnel syndrome, can sometimes be treated with surgery. Additionally, kidney transplantation may stop the amyloidosis from getting worse.
There is a link between amyloidosis and certain types of blood cancer. In particular, about 15 percent of people who have multiple myeloma go on to develop AL amyloidosis. Both of these diseases affect plasma cells, a type of white blood cell found in the bone marrow. Plasma cells produce antibodies, which help fight off infection. When there are problems with the plasma cells, parts of these antibodies, known as light chains, can form amyloid proteins. While amyloidosis is not considered a type of cancer, the same treatments — including chemotherapy — can be effective for both multiple myeloma and AL amyloidosis.
Other cancers can also be comorbid with amyloidosis. About 2 percent of people with AL amyloidosis have B-cell lymphoma. People with amyloidosis may also have Hodgkin lymphoma, medullary carcinoma of the thyroid, and macroglobulinemia.
Most types of amyloidosis are systemic, meaning they affect the entire body. Systemic amyloidosis can cause proteins to build up in multiple organs. These abnormal proteins can damage the organs and prevent them from working correctly. Therefore, amyloidosis can lead to several different complications.
Kidney disease and dialysis treatments can cause dialysis-related amyloidosis, but many types of amyloidosis can also cause kidney disease. Amyloid fibrils often collect in the kidneys, leading to kidney damage or kidney failure.
To diagnose kidney damage, your doctor may collect urine samples to check for high protein levels or blood samples to look for fat, cholesterol, or albumin in the blood. You may also need a kidney biopsy, in which your doctor removes a sample of your kidney tissue and tests for the presence of amyloid proteins and for kidney damage. Treatment for amyloidosis-related kidney problems may include taking medications to support kidney function, reducing the amount of fluids you drink, and eating fewer foods containing salt, cholesterol, and saturated fats.
Amyloid fibrils can collect in the walls of the heart, making it more difficult for the heart to fill with blood between beats. This type of abnormal heart function is called cardiomyopathy. Some people with amyloidosis-related heart symptoms develop arrhythmias (unusual heart rhythms) or experience shortness of breath. Cardiovascular symptoms are more common in the subtypes of amyloidosis caused by the transthyretin (TTR) protein, including wild-type ATTR and hereditary ATTR amyloidosis. When these diseases affect the heart, they are sometimes called cardiac amyloidosis.
Diagnosis of amyloidosis-related heart disease can be accomplished through several methods:
Treatments for cardiac symptoms can include medications that reduce high blood pressure, drugs that help the body get rid of extra water, a pacemaker to correct problems with the heart’s electrical activity, or a heart transplant. Heart problems can be serious or even fatal, so it is important to get proper treatment when amyloidosis affects your heart.
Amyloidosis-related nervous system problems can lead to a condition called peripheral neuropathy. In this condition, the nerves that support the arms, hands, legs, and feet may be damaged. People with neuropathy can develop feelings of tingling, burning, pain, or numbness in these areas.
Having health problems in addition to amyloidosis may complicate treatment and lead to less favorable outcomes. Managing comorbid conditions can improve your quality of life. Make sure to have regular follow-up appointments with your health care team, and bring up any new or unusual symptoms you are having. Speak openly with your team about all of your health concerns, and consider seeking care from an amyloidosis specialist if you are facing challenges while managing this disease.
Through MyAmyloidosisTeam, you can join an online social network for those living with amyloidosis. You will gain access to a social support group of people who are facing similar challenges and who understand what you are going through.
Do you have health conditions in addition to amyloidosis? How are you managing them? Share your experience in the comments below, or start a new conversation on MyAmyloidosisTeam.
Richard LoCicero, M.D.
has a private practice specializing in hematology and medical oncology at the Longstreet Clinic Cancer Center, in Gainesville, Georgia. Review provided by VeriMed Healthcare Network.
Learn more about him here.
Maureen McNulty
studied molecular genetics and English at Ohio State University.
Learn more about her here.
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My husband has shooting pain in his right shoulder but he has a torn rotator cuff but not related to cardiac amyl.
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