Talk:Amyloidosis

So, what IS Amyloidosis?
One of the things I like(d) about Wikipedia is that even laymen can look up things like "Amyloidosis" and get an idea of what it is without having to deal with the jargon of that specific area.

However, this article is incomprehensible. Someone please make it comprehensible.


 * Seconded. I have no idea what the heck I just read, or what the disease affects, say nothing of what it does.  I got more information from the article on Robert Jordan about the disease... 71.198.127.97 23:29, 29 April 2007 (UTC)


 * Unfortunately true. I had a long battle over at Hilbert space about making the intro paragraph comprehensible to a layperson, but to no avail.
 * This one seems to have a similar problem: someone who already understands it would find it to be a fine article, but for someone who doesn't know what's going on, it's pretty useless.
 * I'll have to see if I can find the appropriate tag to get an expert in to explain it.
 * * Septegram * Talk * Contributions * 17:30, 7 June 2007 (UTC)

I am an intelligent person and all it does it explain scientifically what is going on. It is quite uninformative for someone who wants to know the basics of the disease. All it did was leave questions unanswered and my head spinning. This is the worst article I've ever seen on here. The problem is that this is a rare disease and there are few who understand it, including many doctors. I will refer this to an internist that I know who is great at writing.71.93.201.164 (talk) 16:40, 1 February 2014 (UTC)Carolyn Smith

What it isn't?
"CJD, Alzheimer's and diabetes are almost never referred to as amyloidoses. However, all of these diseases, as well as some other disorders, are considered to be types of proteopathy, in which structurally aberrant proteins accumulate in certain cells and tissues."


 * I hav no clue why these diseases wouldn't be referred to as amyloidoses. I'm reading through the whole article after that, just to see why they might not fit, but my impulse is to snip. Brewhaha@edmc.net 08:08, 8 May 2007 (UTC)

This article is Terrible
Completely incomprehensible with loads of spurious detail and no overview at all-the opening sentence, is laden with medical jargon and factually wrong to boot. This needs a complete rewrite. I will do this when I've got time-possibly this weekend.  Felix Felix talk 14:04, 13 July 2007 (UTC)


 * Thanks,  Felix . When it's readable to a normal mortal, please feel free to yank the template I added.
 * * Septegram * Talk * Contributions * 16:43, 13 July 2007 (UTC)

It's a start
Next is sorting out the organ specific amyloidoses and then referencing and expanding. Perhaps a bit on biopsy to go with the histology section, and a table of all the precursor proteins. Also a section on clinical features of the systemic amyloisoses before the organ specific ones, perhaps. Hopefully it's all becoming a bit clearer, due to drastic simplification.  Felix Felix talk 22:20, 14 July 2007 (UTC)

Mortality Rate?
Is it fatal? what percentage of people die from it. Robert Jordan is one of my favorite authors, so I am really quite concerned.
 * Yep, they do-the mortality depends on what type they have and whether they get treatment for the underlying cause or not.  Felix Felix talk 20:23, 26 July 2007 (UTC)
 * RJ's gettin past it i think, he's helping test a new drug that is showing excellent results. his lamba light chains are within normal range now, but he's still dealing with it, but with less struggle than normal —The preceding unsigned comment was added by Special:Contributions/ (talk)
 * Yes, it is fatal. It doesn't necessarily progress as fast as some cancers do but many cases are fairly asymptomatic until it's too late. While a patient might otherwise be able to get a heart or lung (or other organ) transplant, the doctors will not do an organ transplant in an amyloidosis patient until certain conditions are met. The patient must have free light chains lab results that are within normal parameters and bone marrow biopsies must also indicate that the disease has been sufficiently suppressed. If the patient is too ill to withstand the level of chemotherapy necessary to bring the condition within "normal" parameters, he or she may never qualify for the organ transplant and their condition will just continue to degrade until they expire. There is no "silver bullet" drug; there are a host of treatments that may be offered, but often times several years pass and several different treatment protocols are attempted before a good response to treatment is achieved - if it is ever achieved. While we do not refer to it as "remission", there are some who have had good, "durable responses" who have survived fifteen or twenty years after a successful treatment. But even those patients are strongly advised to return to their treatment center for an evaluation at least once per year. HDM/SCT (high dose melphalan with stem cell transplant) can only be done a maximum of two times, so if that was the treatment that brought the patient within good/reasonable parameters and they've had HDM/SCT twice already, if their blood work or bone marrow biopsy indicates that the disease is on the rise again, they'll have to find another treatment that will hopefully work. Once a patient has been diagnosed with amyloidosis, they will almost assuredly die from it eventually; it's just a matter of time. Unless of course, they get hit by a car first or something like that! And if the patient undergoes much chemotherapy, he or she may be fairly immunocompromised and at risk for other major health issues. Zapriori (talk) 00:30, 11 March 2010 (UTC)

GI manifestations
reviews the manifestations of amyloidosis on the digestive tract. JFW | T@lk  09:22, 16 December 2007 (UTC)

AL amyloidosis
Review of AL by the people from the UK amyloidosis centre. JFW | T@lk  10:46, 24 January 2008 (UTC)


 * That link didn't work when I tried it, JFW. Nbauman (talk) 12:04, 24 January 2008 (UTC)
 * Talk-reading colleagues should take care to note that "JFW" is not necessarily shorthand for JFWIW ...& esp. not in this talk section. --Jerzy•t 07:33, 11 September 2018 (UTC)

Classification
Since the amyloidologists like to classify amyloidosis on the basis of the type of amyloid, and the pathologists like to classify based on disease process, I've included a brief table of types of amyloid, which are referred to elsewhere, I know, but I think this is a bit neater. The systemic amyloidosis part needs more work, and I think some more info on pathogenesis, clinical correlartion & prgnosis would be useful. If I get time, I'll do it, but if someone else wants to, feel free. Mattopaedia (talk) 06:54, 6 March 2008 (UTC)
 * Although it's a nice looking table-I really don't see what this adds at all, apart from making the article more confused-it randomly mentions some amyloid proteins that are already classified sensibly, and others which aren't really amyloid proteins at all (which are also mentioned). I really want to remove this, but I thought I'd raise it here first.  Felix Felix talk 10:56, 8 March 2008 (UTC)
 * Sorry Felix, perhaps I wasn't being clear in my comments above, so I'll try to be clearer, because I believe the table will ultimately be of value to the article.
 * This article is, to me, not a clear representation of the disorder, & needs improving. That's what I've set out to do.  I'm a busy man, so I'm not going to do it all at once.  I will help it evolve as my time allows.  I notice you've made a lot of edits here.  Perhaps you feel this is your "baby" and don't want some stranger fiddling with it.  I know the sense of pride one gets from producing an article that seems like a wondrous piece of work.  But this has to grow, so please, give it a chance.  I don't want to disfigure your work, only enhance it.
 * I'm sure you know there are two common methods of classifying the amyloidoses -1.) On the amyloid type, and; 2.) On the clinical manifestation of the amyloid type. There is, of course, a combination of these two, also commonly used.  I believe this needs to be indicated in the article.
 * Clinically, Systemic Amyloidosis is an entity that is subclassified into the primary and secondary amyloidoses. Localised amyloidosis is often considred seperately, but it can be AL-type, which makes it (in many cases) to be a primary amyloidosis.
 * Primary amyloidoses are associated with immunocyte dyscrasias & are the most common type.
 * Secondary amyloidoses occur as a result of some underlying chronic inflammatory or destructive process.
 * I believe the classification as it stands in the article does not clearly convey this, and my intention is to re-write so that it does.
 * My aim is to create an article that gives some consideration to the above points.
 * I disagree that the list of amyloid proteins is "random." You will notice that the list starts with primary (AA) then the more common secondary types, which, I believe, I have ordered by prevalence.
 * I disagree that the tabled proteins are already classified sensibly. There is scant consideration to the vagaries of classifaction I have outlined above.
 * I disagree with your assertion that some "aren't really amyloid proteins at all." Although there is controversy surrounding the definition of amyloid, I believe that any extracellularly deposited protein which has a β-pleated sheet configuration and which demonstrates green birefringence is generally accepted to be an amyloid protein.  All of the proteins I have listed fit this classification.
 * On a personal-style note, I found your edit comment of "uugh!" somewhat offensive. Add that to the style of comment you've written above, and it makes your input here seem to me to be flippant and disrespectful of the time and effort of a medical colleague, who, like yourself, has an interest in providing good-quality free & readily accessible information. Whilst I thank you for your interest in my edits, I will respectfully request that your responses be more considered. Maybe I'm being oversensitive, I don't know, but it pays to be nice.  Have a good day!
 * Mattopaedia (talk) 02:01, 11 March 2008 (UTC)
 * Fair enough, if you want to put time and effort into improving this article, that's great. I won't get in your way, but if I don't like the end result, I won't be backward about coming forward. And if you find my edits and edit summaries flippant and disrespectful, then sorry, I do think you are being oversensitive.  Felix Felix talk 14:22, 11 March 2008 (UTC)

More on classification
Now, I've had a closer look at the classification info in this document, and it was a reasonable departure from my understanding of its classification. So I've read Robbins Pathology, Harrisons Internal Medicine & Cecil Medicine, and all of them describe the classification essentially as I've put it (which is why I made these changes - I'm more inclined to believe thos texts, & would like wikipedia to be as credible). Again, I went with another table, because I feel it gives the reader q quick overview, and they can then go on to read more if they desire, rather than having to scroll through screens of prose. I've made no changes to the section on localised amyloidosis, only because I haven't had the time to look closely at it yet. In due course, I shall. There should be something written on pathogenesis, clinical presentation, prognosis and treatment. Cheerio! Mattopaedia (talk) 05:07, 11 March 2008 (UTC)

Is this a prion disease?
Hi, Is Amyloidosis a prion disease? Could it be diet-related? Thanks, Bennie —Preceding unsigned comment added by 66.57.189.224 (talk) 18:18, 17 May 2008 (UTC)

John Smith
Who is John Smith?128.208.1.225 (talk) —Preceding comment was added at 21:33, 11 July 2008 (UTC)

Primary Systemic Amyloidosis Clinically Confined to the Heart.
Diagnosis: Primary Systemic Amyloidosis Clinically Confined to the Heart. Diagnosis made May, 1994- Jefferson University Hospital- Philadelphia, Pa., USA. Diagnosis confirmed -Mayo Clinic, Rochester, Minn., USA - June, 1994. Diagnosis confirmed - Boston University Hospital, Boston, Mass., USA - July, 1994. AL. Lambda Light Chains. Treatment: Autologous Bone Marrow Transplant with Stem Cell Rescue - August 1994 - Boston University Medical Center Hospital (#2, tip of the hat, Lou - #1) Prognosis: They don't call me "THE CHOSEN ONE" for nothing. As for "Clinically Confined to the Heart" its more like "THE ONLY ONE" - 14+ years later.

http://sites.google.com/site/curedofamy/ —Preceding unsigned comment added by Jrhelwig (talk • contribs) 23:44, 22 November 2008 (UTC)

Is amyloidosis the leading cause of death in supercentenarians?
On BBC Radio Four in August 2009, there was a programme on supercentenarians (broadcast on August 12 at 9 p.m., 2009). To accompany the programme, there was an article in the Radio Times for August 8-14, which claimed that amyloidosis is the leading cause of death of supercentenarians. The article also claimed that this has a similar aetiology to Alzheimer's disease, but does not affect the brain. Is this accurate? I know that the "Radio Times" is hardly the Lancet or the New England Journal of Medicine or the British Medical Journal and does make errors on occasion, but if any one find a reliable source for this claim, it would be good if it could go in the article here. It would also be a good way of linking this article to the article on supercentenarians. ACEOREVIVED (talk) 21:20, 4 October 2009 (UTC)

What are the symptoms of amyloidosis?
This article needs symptoms. (I'm diagnosing this article as lacking symptoms). I'd fix it but I'm not a doctor or expert like you probably are who is reading this. :)--Tomwsulcer (talk) 15:56, 5 October 2009 (UTC)

Symptoms, Treatments, Lay v. Medical Specialist Content, etc.
I'm usually interested in the grammar, spelling, polish, etc. of web pages in general and Wikipedia in particular, but have a vested interest in conveying accurate information about amyloidosis to the general public. I agree that this page needs work but am not here to criticize, only to try to improve it.

I have attended a significant number of patient support group meetings and know that patients and their families and friends are often scared and bewildered by such a diagnosis because they most likely have never heard of it before, the treatment options may seem very serious, the diagnosis may have been made later than it should have been, and it seems to be a difficult disease to comprehend particularly for lay persons. Newly-diagnosed patients often are so distressed by the seriousness of the disease that they don't understand the explanation they may have heard thus far, and may misunderstand what was said to them, what the disease is and what the treatments even try to accomplish. It may be difficult for some medical specialists to convey their understanding of the disease to lay persons as well.

Though I have some good knowledge of the disease, I am not a formal medical professional and cannot claim great medical accuracy in some descriptions or explanations in support group meetings. However, the medical staff at the BUMC Amyloidosis Research and Treatment facility does not seem to take exception to my comments.

I have been told some of the following factoids by medical staff or else have read it in printed materials provided by BUMC or various amyloidosis organizations. Things that lay persons and newly-diagnosed patients may do well to understand may include:
 * Amyloidosis affects approximately 8 persons per million, or somewhere between 2,000 and 3,000 persons diagnosed per year in the U.S.A.
 * We believe that amyloidosis may be under-diagnosed. A patient may be diagnosed with cardiovascular disease, for example, simply because it is far more common especially in the same age group that is affected by amyloidosis. Without a tissue biopsy or at the very least a cardiac echogram, the amyloidosis may not be correctly diagnosed.
 * Amyloidosis refers to a group of diseases, which other contributors have already made a good effort to describe.
 * Persons have made remarks regarding amyloidosis and Alzheimer's. It is my understanding that they are related diseases. Amyloidosis involves lambda- and kappa- free light chains while Alzheimer's involves beta free light chains. Amyloidosis can involve virtually any organ of the body except the brain (including the skin); Alzheimer's affects (perhaps) only the brain tissue.
 * My understanding of the disease (at least for Primary AL) is that it is originated in the bone marrow, that some regions of bone marrow seem to become rather "reprogrammed" to produce the proteins that the body cannot use and is not able to eliminate. The amyloid fibrils float around the bloodstream for awhile until settling into some organ or organs, where they begin to corrupt the qualities of the tissue. For example, the heart and lung tissue become thicker and stiffer, degrading the performance of those organs. The kidneys are affected by passing larger substances; protein leakage ("proteinuria") goes from a normal level of about 0.1 gram to an abnormal higher level of leakage of a gram or substantially more.
 * Patients I have met have had amyloidosis in tissue and organs including but not limited to kidneys, heart, lungs, pancreas, liver, thyroid, skin, larynx, eyes, tongue, gastrointestinal tract. If diagnosed early, it may be manifested in only one organ. If diagnosed later, other organs are likely to be involved. Some patients present particularly complicated cases in that they are not able to be categorized simply as Primary AL or AA or Familial, but seem to present as more than one such category, which may impact the ability to provide an effective treatment.
 * Even if a patient is diagnosed, there is no certainty that a particular treatment or set of treatments will result in a reduction of the disease. We do not consider there to be a cure for the disease at this time but only regard as "successful" treatments that create a lasting response that appears to have significantly stopped the production of amyloid fibrils and the imbalance of lambda and kappa free light chains. We may regard this as one would a remission of cancer. The amyloidosis may succeed in becoming productive again after some period of time.
 * If a medical professional (a GP, e.g.) detects something that could possibly be one of the amyloidosis variants, either a tissue biopsy and/or a blood serum free light chains test may be very helpful in shedding light on the situation. In the case of the tissue biopsy, the sample is usually sent to a laboratory that prepares the sample specimen with Congo Red stain and is inspected under polarized light for evidence of "apple green" birefringence. The blood serum free light chain test is a simple test to order that can indicate a gross elevation of either lambda or kappa free light chains, or simply indicate that the ratio of the two is not close to unity.
 * Treatments that I am aware of include high-dose intravenous melphalan with autologous stem-cell transplant. This is a somewhat newer treatment that has come into vogue in the past dozen years or so. The melphalan is administered over the course of two days and kills rapidly-dividing cells, the intentional target being the bone marrow in the attempt to destroy a sufficient amount of the corrupted bone marrow that is producing the amyloid. The adult stem cells are given to the patient a day or two after the second day of melphalan.
 * A treatment that has been used in the U.K and elsewhere for some years is referred to as "VAD", for Vincristine, Adriamycin (now called doxorubicin) and Dexamethasone, which is a steroid.
 * For patients who are unable to withstand high-dose IV melphalan treatment, oral melphalan is sometimes a treatment, sometimes also accompanied with dexamethasone.
 * A treatment that has become available within the past several years is a protease inhibitor, Velcade (bortezomib). The action of protease inhibitors is novel and interesting in that they are not a substance of a toxic nature as melphalan and vincristine are, for example.
 * Another treatment that has also had some success with some patients is Revlimid (lenalidomide, a derivative of thalidomide), an immunomodulator.
 * Some treatments have been combined to provide better efficacy. For example, it is not uncommon for dexamethasone to be used as part of a treatment of Velcade or Revlimid. Sometimes oral melphalan is also included in treatment, though its dosage is much lower than the high-dose IV melphalan.

Even though we appear to have a wide variety of drugs to choose from for chemotherapy, I believe that we're barely scratching the surface of therapies and that far better therapies must be developed that do not have the wide-ranging, debilitating and high-risk side effects of current treatment options.

Regarding prion disease, it wouldn't surprise me if researchers are able to draw a connection between something like BSE and amyloidosis sometime in the next couple of decades. I think it's an interesting question. Better understanding of either of them may lend better understanding to the other. Funding for research is a bit of a sore subject for any of the rare diseases, so research progress is unfortunately apt to be much slower than with the much better-known diseases. It would be interesting to collect data on patients in regards to their diet to see whether vegetarians are as likely to contract amyloidosis as omnivores are. I am only aware of a handful of sites in the world that are actively participating in amyloidosis research. Some of the the treatments we currently have or are investigating for use on amyloidosis are fallout from other treatment programs such as Multiple Myeloma or various cancers.

Some of my initial research of amyloidosis on the web about five years ago initially led me to mistakenly believe that there was an inherent connection to Multiple Myeloma. It is not a given that an amyloidosis patient also has Multiple Myeloma. Some do; many do not. I hope that this Wikipedia article can help patients and families (and even some medical personnel who have little or no first-hand experience of amyloidosis) clarify this and other aspects of the disease.

Researchers that I either know or know of include Skinner, Seldin, Gertz, Comenzo, Dember, Sanchorawala and others. I hope that some of the folks in research can help us beef up the content and clarity of the page so that it is of use to patients, families and friends of patients and medical personnel as well.

Zapriori (talk) 12:18, 10 March 2010 (UTC)

Type AA Amyloidosis Prognosis
"SECONDARY AMYLOIDOSIS is caused by a chronic infection or inflammatory disease such as rheumatoid arthritis, familial Mediterranean fever, osteomyelitis, or granulomatous ileitis. The deposits in this type of the disease are made up of a protein called the AA protein. Medical or surgical treatment of the underlying chronic infection or inflammatory disease can slow or stop the progression of this type of amyloid."

http://www.amyloidosis.org/whatisit.asp

I submit "Type AA" Amyloidosis is not "terminal" and not necessarily "usually fatal." --Remingtonhill1 (talk) 03:12, 1 May 2010 (UTC)

Epidemiology
doi::10.1111/bjh.12286 - the British expert centre has estimated that the incidence is 0.8/100,000 most of which AL amyloid. This will require a secondary source for confirmation. JFW &#124; T@lk  18:11, 11 March 2013 (UTC)

Pathology: protein fragments?
Is "protein fragments" an awkward way of expressing that some proteins are made of more than one peptide chain? Or do cells make other kinds of protein fragments? Monado (talk) 17:55, 4 May 2014 (UTC)


 * It's part of a big chunk of text added back in 2010 (diff) by someone who was apparently trying to simplify or avoid certain technical terms. The editor may not have been entirely comfortable in the English language, as well.  While some of this editors' work has since been revised (reference to the spleen "exploding" has been replaced with rupturing, for instance), there's still a lot of editing needed.
 * There are a few things that the text could be trying to describe, depending on which particular amyloid disease the writer had in mind; it's certainly not clear. If they're thinking of light chain amyloidosis, for instance, then yes&mdash;they're describing a protein subunit (immunoglobulin light chain) that forms covalent links with other polypeptides (a total of two each of Ig heavy and Ig light chains) to make a complete antibody molecule.  If they're thinking of familial amyloid polyneuropathy, then they're describing a transthyretin (TTR) monomer, which normally forms a non-covalent complex of four identical TTR units.  If they're thinking of beta amyloid, it's a little tiny cleavage product that results when the gamma secretase protease cuts a piece off the amyloid precursor protein (APP). TenOfAllTrades(talk) 18:41, 4 May 2014 (UTC)

The page is confusing the category of diseases called "amyloidoses" with specific types of amyloidosis
The amyloidosis article is a bit of a mess right now. The article confuses the generic term amyoidosis with the various different specific types of amyloidoses. It seems to me that this article should be describing the category of diseases that encompass the amyloidoses and that specific information about the various types (light chain amyloidosis or AA amyloidosis or whatever) should be contained in their own articles. I'm not really sure about how to go about doing this....would appreciate any help.

I've deleted the section on signs / symptoms because this is really meaningless when discussing the large number of diseases called amyloidoses. It seems that most of the signs/sx were talking about light chain amyloidosis, not the many other kinds that exist.

Wawot1 (talk) 16:33, 8 May 2014 (UTC)

Many recent edits seem to be making the confusion worse, not better...amyloidosis is not a single disease, but a category of diseases. Need to clarify this. Wawot1 (talk) 08:22, 15 November 2014 (UTC)

Peer Review
Hi, thanks for taking on this challenging article. It will be a great resource to those within and outside of the medical community. As noted above by another reviewer, I think it would be good to emphasize that amyloidosis is not one disease but encompasses a spectrum of diseases. Here are my comments based on the areas of focus you noted:

A) intro
 * Could delete “in medicine”
 * Maybe simplify lead and just say, “amyloids are insoluble proteins and can deposit in a number of organs or tissues, disrupting normal function.”
 * Might add a line at the end like- “Although they can affect almost every organ, amyloid typically deposit here x x…. leading to blank ….”

B) Subsection classification:
 * if you wanted you could break down the signs and symptoms section which is quite long and create organ system subheadings: heart, kidney, liver, etc or Create subsections based on AA, AL, etc (could give brief overview of these processes and link to more detailed articles)
 * Tighten up the proteolysis discussion in the pathogenesis section - some redundancy here. “This happens b/c the misfolded proteins become robust enough…” and “the reason they aggregate…” sentences basically say the same thing, just the later more sophisticated than the former.

C) other Jmtseng (talk) 23:47, 17 November 2014 (UTC)
 * If I were a lay reader, I wouldn’t understand AA vs AL amyloidosis, which is introduced somewhat abruptly in the signs and symptoms section. Maybe clarify those terms briefly in S/S section.
 * Pathogenesis section: create new sentence for: “proteases come and digest the misfolded fragments and proteins”

History
I'm copying here an old stub named Amyloid degeneration which is now a redirect to the present page, since some of the content of the old stub might be relevant (source) to ==History== here:

Amyloid degeneration is a type of degeneration with the deposit of lardacein in the tissues. It indicates impairment of nutritive function and is seen in wasting diseases.

It is also sometimes called Abercrombie's disease, Abercrombie's syndrome, Virchow's syndrome, bacony disease, cellulose disease, hyaloid disease, lardaceous disease, waxy disease, and waxy degeneration. Its alternate names honour Scottish physician John Abercrombie and German physician Rudolf Ludwig Karl Virchow.

5.80.198.100 (talk) 18:24, 1 July 2015 (UTC)

Rare?
Looking at the current lede sentence;

"Amyloidosis is a rare disease that results from accumulation of inappropriately folded proteins."

Two complaints about this line. 1) It seems like it's ripped off from here. 2) I think Alzheimer's might technically count as an Amyloidosis (ref 1,2,3), in which case using the term "rare" seems wrong.

Anyone with more expertise on this than myself want to comment? NickCT (talk) 18:32, 27 October 2015 (UTC)
 * Perhaps the sentence can be rewritten and the word "rare" avoided? --My Core Competency is Competency (talk) 20:08, 27 October 2015 (UTC)
 * It seems http://www.thevisualmd.com is an unattributed WikiPedia clone, we should probably get in touch with WMF-legal.
 * Localised amyloid deposits ≠ amyloidosis
 * It is pretty rare, sure we could specify, but I don't see why we would need to remove it.
 * CFCF  💌 📧 21:22, 27 October 2015 (UTC)


 * re "clone" - Scanning through their stuff it seems like most of what they have is attributed to the National Library of Medicine. Why do you think it's a clone of us, rather than us being a close of them?
 * re "amyloid deposits ≠ amyloidosis" - Really? So which amyloid deposit diseases count as amyloidosis? Where's the list? Why do some sources call Alzheimer's amyloidosis? NickCT (talk) 21:50, 27 October 2015 (UTC)
 * re "amyloid deposits ≠ amyloidosis" - Really? So which amyloid deposit diseases count as amyloidosis? Where's the list? Why do some sources call Alzheimer's amyloidosis? NickCT (talk) 21:50, 27 October 2015 (UTC)


 * re "clone"&mdash;it looks like VisualMD.com is lifting text from multiple Wikipedia articles without attribution, and claiming copyright on it. The first randomly selected medical articles I looked at (schizophrenia and lung cancer, compare:, ) do exactly the same thing: copying the lede from Wikipedia's articles and adding them to the bottom of their pages.
 * re "amyloid deposits ≠ amyloidosis"&mdash;yes, really. It's a semantic thing related to the way that physicians typically use the terms, rather than the straightforward "sensible" interpretation of what the terms perhaps "ought" to mean.  And in any field, you'll find a few rebels who want to argue the point.  (I don't think the rebels have reached critical mass in this particular field, to the point where Wikipedia should adopt their broader definition.)  It's similar to how the word chemotherapy in most contexts is just presumed to mean chemotherapy for cancer treatment, even though the word's meaning is much broader. TenOfAllTrades(talk) 22:49, 27 October 2015 (UTC)
 * apparently it does seem to be VisualMD.com (in regards to use of this Amyloidosis article term I agree w/ TenOfAllTrades)--Ozzie10aaaa (talk) 08:57, 28 October 2015 (UTC)
 * - Good analogy to chemotherapy. One thing I'm still left wondering is how many "rebels" one needs before there's a critical mass. Clearly there are at least a few high-quality RS's which explicitly and specifically call things like Alzheimer's amyloidosis. I'm not sure the same applies to chemotherapy.
 * And how do we know that VisualMD is lifting from Wikipedia rather than vice versa? NickCT (talk) 13:19, 28 October 2015 (UTC)
 * Regarding terminology&mdash;I wouldn't say that the field has adopted a broader definition until it shows up in standard textbooks. (
 * Regarding VisualMD, it's pretty obvious from the structure of their pages. (Follow the links provided.)  In all cases, the VisualMD site has a summary from somewhere else (not sure if they're creating them in-house or scraping them from some other site(s) or some combination of both), followed by a direct copy of the exact text of the Wikipedia article lede (including the bolding of alternate article titles) with the footnotes stripped.  It strikes me as exceedingly implausible that on some of our more highly-watched and -edited medical articles someone could copy & paste in an entire lead section, and that they (or someone else) would subsequently, meticulously add ten or a dozen citations without altering a single word of the text.  It's even more implausible that someone would do so while only copying the bottom half of the VisualMD page, and even more incredible that the VisualMD page would happen to be precisely created so that the bottom portion of their text would function as a standalone Wikipedia article lede. TenOfAllTrades(talk) 15:03, 28 October 2015 (UTC)
 * - The "text book definition" standard seems reasonable.
 * Re VisualMD - Ah Ok. So it just seems very improbable that WP is stealing. Agreed. For a second I thought you might have some way to absolutely confirm which direction the thiefery was going. ;-) NickCT (talk) 19:56, 28 October 2015 (UTC)
 * The claim is verifiable. Both NORD and Orphanet list it:  Search for it at NORD and page at Orphanet.  WhatamIdoing (talk) 18:31, 28 October 2015 (UTC)
 * - Which claim? NickCT (talk) 19:56, 28 October 2015 (UTC)
 * The claim that amyloidosis is a rare disease. WhatamIdoing (talk) 21:10, 28 October 2015 (UTC)
 * The first link doesn't seem to work. I don't see where it says it's rare in the second. Regardless, I guess I was more curious about whether Alzheimer's was an amyloidosis (because if it is, then "rare" clearly isn't true). I think TenOfAllTrades touched on the right point which is that Amlzheimer's doesn't meet the text book standard for amyloidosis. NickCT (talk) 14:52, 29 October 2015 (UTC)
 * Being a rare disease is a criteria for Orphanet inclusion. CFCF   💌 📧 15:48, 4 November 2015 (UTC)

Lancet Seminar December 2015
Lancet. 2015 Dec 21. pii: S0140-6736(15)01274-X. doi: 10.1016/S0140-6736(15)01274-X. Systemic amyloidosis. Wechalekar AD1, Gillmore JD2, Hawkins PN2. --Nbauman (talk) 06:36, 17 February 2016 (UTC)


 * Now in print issue 10.1016/S0140-6736(15)01274-X JFW &#124; T@lk  12:52, 24 June 2016 (UTC)

Cerebral Amyloid Angiopathy
While this is a separate entity, they are both often referred to as amyloid. Should there be a disambiguation?

Thanks. Streddy75 (talk) 13:17, 21 October 2016 (UTC)

"Classic facial features of AL amyloidosis" - are we happy with this?
Given that this (amyloid purpura) is very far from common (15% according to the ref on that WL) it's perhaps not appropriate to have this image so prominent. Perhaps it should be under signs and symptoms? Thoughts? - Snori (talk) 03:19, 15 April 2019 (UTC)

Queen’s University Student Editing Initiative
Hello, we are a group of medical students from Queen’s University. We are working to improve this article over the next month and will posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. Jan2020-med2024 (talk) 20:17, 23 November 2020 (UTC)
 * Hi, welcome! I'll keep an eye on this page, so if you have questions about Wikipedia as you dive in, feel free to let me know. I'm glad to see more interested folks taking a look at medicine-related articles! There's lots to be done around here. I hope you're all staying well during these crazy times. Best, Ajpolino (talk) 03:05, 24 November 2020 (UTC)

Suggested change # 1: Prognosis section.
Croissanttabletennis (talk) 17:24, 4 December 2020 (UTC)
 * Original: Prognosis varies with the type of amyloidosis. Prognosis for untreated AL amyloidosis is poor, with median survival of one to two years. More specifically, AL amyloidosis can be classified as stage I, II or III based on cardiac biomarkers like troponin and BNP. Survival diminishes with increasing stage, with estimated survival of 26, 11 and 3.5 months at stages I, II and III, respectively.
 * Proposed Improvement: Prognosis varies with the type of amyloidosis and the affected organ system. Prognosis for untreated AL cardiac amyloidosis is poor, with a median survival of six months. More specifically, AL amyloidosis can be classified as stage I, II or III based on cardiac biomarkers like Nt-proBNP and cardiac troponin. Survival diminishes with increasing stage, however recent advancements in treatments have improved median survival rates for stages I, II, and III, to 91.2, 60, and 7 months respectively.
 * Rationale for proposed change: The original statement regarding how prognosis of amyloidosis is different for each type of amyloidosis should also take into consideration how prognosis can change depending on what organ systems are primarily affected. For the second proposed change, N-terminal prohormone BNP (NT-proBNP) has been demonstrated to be a more robust marker for amyloidosis than BNP and a highly useful prognostic determinant. For my final proposed change, recent estimates for AL cardiac amyloidosis seemed to have narrowed the range for median survival of untreated cases to around 6 months, but I believe that it is worth mentioning how therapeutic advancements have altered disease progression and its effects on survival. There are now many therapies being developed and including this information in the paragraph modernizes and gives a more in-depth look at prognosis for individuals' looks today. The information comes from these sources:
 * Hi, Thank you for sharing this here . Your groups is doing great so far. Do you mind including the citation that you propose to use for this article improvement? Is the first paragraph that you wrote what you are suggesting to add to Amyloidosis? Please also try to include a citation after every sentence that you plan to add to Wikipedia- even if it needs to be repeated.JenOttawa (talk) 17:18, 4 December 2020 (UTC)
 * My apologies, I wasn't sure what was expected in the Talk page upload. Here is what I posted in my sandbox(talk) 17:24, 4 December 2020 (UTC)
 * No problem at all. I re-formatting a little so that the other members of your group can use a similar template. Great work so far! Thanks for sharing the additional info.JenOttawa (talk) 17:35, 4 December 2020 (UTC)
 * Note I also added your references using the tool that I demonstrated in our lecture (and-"re-used #2 so you do not have a duplicate ref in your reference list). Please do practice in your sandbox before editing live on Dec 7th! If you have any questions don't hesitate to reach out. JenOttawa (talk) 17:36, 4 December 2020 (UTC)

Thank you for the feedback! Croissanttabletennis (talk) 17:39, 4 December 2020 (UTC)

Suggested change # 2: Amyloidosis
Targeted sentence: “In ATTR, liver transplant is a curative therapy because mutated transthyretin which forms amyloids is produced in the liver.[7] ” Proposed Changed: Management of ATTR amyloidosis will depend on its classification as wild type or variant. Both may be treated with tafamidis, a low toxicity oral agent that prevents destabilization of correctly folded protein. Studies showed tafamidis reduced mortality and hospitalization due to heart failure. Previously, for variant ATTR amyloidosis, liver transplant was the only effective treatment. However, newer therapies including diflunisal, an anti-inflammatory drug, and inotersen and patisiran, drugs which prevent misfolded protein formation, have shown early promises in slowing disease progression. The latter two drugs have shown their benefit in neurological impairment scores and quality of life measures. However, their role in cardiac ATTR amyloidosis is still being investigated. Rationale for proposed change: This sentence was outdated: The supporting reference is from 1997 and management has evolved since then. Newer agents have emerged that have demonstrated effects on slowing disease progression. Area of controversy: There is some ambiguity on this topic as some of the information regarding management with medication is still being uncovered. When proposing changes, I tried to make it clear that these are early promises.

This sentence is incomplete: The sentence does not differentiate between wild type and variant type ATTR amyloidosis which have some differences in management. Also, it did not specifically describe the benefits of treatment including the mortality and quality of life. KarnPuri22 (talk) 18:39, 4 December 2020 (UTC)
 * Great work so far. Please note, when adding your citations, the citation goes immediately after your punctuation like this. Great work re-using the same citation and with your formatting. Thanks! JenOttawa (talk) 19:16, 4 December 2020 (UTC)

Suggested change #3:
I propose the following addition to the Amyloidosis section: Proposed addition: The vast majority of proteins that have been found to form amyloid deposits are secreted proteins, so the misfolding and formation of the amyloid occurs outside cells, in the extracellular space. There is currently no evidence of any structural or functional similarities between the different types of proteins vulnerable to misfold into amyloid. Thirty-seven proteins have been identified as being vulnerable to amyloid formation, and only four are cytosolic. One third of amyloid disease is hereditary, in which case there is normally an early age of onset. Half of amyloid-related diseases are sporadic and have a late age of onset – in these cases, the protein aggregation is due to a progressive loss of the body’s ability to regulate protein formation, with aging. A small number of amyloid disorders occur as a result of medical treatment.

Rationale for proposed change: I propose adding the above text to give readers more context about the origin of amyloidosis in terms of risk factors – I think it could be helpful to someone who’s just been diagnosed with amyloidosis to know that there is often little rhyme or reason to who gets the disease, in case they’re having feelings of guilt or fears around risk factors they could have been exposed to. Also, I talked a little bit about where things happen spatially, which I hope could be helpful for people trying to visualize these processes, as histological processes are often hard to picture or conceptualize.

Thank you! I appreciate your time and look forward to your feedback. REIJONES (talk) 18:52, 4 December 2020 (UTC)
 * Thank you for all your hard work and for sharing this here. I adjusted your edit to "re-use" your citation (versus having it repeated in the reference list). When you add your references while editing the actual article, you can see the options "automatic  Manual   Re-use". The first time you add the citation (if it is not already used in an article, click "automatic" and add your PMID, DOI, or website, then click "generate" to fill the template. The second time you want to use the same citation in an article, click "reusue" and search for your citation in the list. This adds in the a,b,c versus duplicating the citation in the list. If possible, practice this in your sandbox before editing live on Monday. Thanks again! JenOttawa (talk) 19:13, 4 December 2020 (UTC)

Suggested change # 4: Amyloidosis
Original text: “Tissue can come from any involved organ, but in systemic disease the first-line site of the biopsy is subcutaneous abdominal fat, known as a "fat pad biopsy", due to its ease of acquisition versus biopsy of the rectum, salivary gland or internal organs. An abdominal fat biopsy is not completely sensitive, and sometimes, biopsy of an involved organ (such as the kidney) is required to achieve a diagnosis. For example, in AL amyloidosis only 85% of people will have a positive fatpad biopsy using Congo red stain. By comparison, rectal biopsy has sensitivity of 74–94%.”

Proposed change to text: A sample of tissue can be biopsied or obtained directly from the affected internal organ, but the first-line site of biopsy is subcutaneous abdominal fat, known as a “fat pad biopsy”, due to its ease of acquisition. An abdominal fat biopsy is not completely sensitive and may result in false negatives, which means a negative result does not exclude amyloidosis diagnosis. However, direct biopsy of the affected organ may still be unnecessary as other less invasive methods of biopsy can also be used, including rectal salivary gland biopsy, lip, or bone marrow biopsy which can achieve a diagnosis in up to 85% of people. Rationale for proposed change: The article previously did not explain what was meant by “involved” organ, and lists the “rectum, salivary gland, or internal organs” as examples. I wanted to be more clear and specify that there is a difference between sampling the internal organ and sampling other tissue. I also provided an explanation for what it means when a test is not “completely sensitive” by explaining that false negatives may occur, which means that a diagnosis cannot be excluded yet. The article then states that the biopsy of the “involved” organ is required to achieve diagnosis, but then proceeds to give “rectal biopsy” as an example, yet the rectum is not related to the usual “involved” internal organs (i.e. rectal biopsy is not biopsy of the “involved organ”; it is another alternative to direct organ biopsy). I wanted to make it clear that direct organ biopsy (e.g. if you suspect the kidney has amyloid tissue, then you would sample the kidney) is often unnecessary as many less invasive diagnostic techniques exist. I also wanted to update the provided statistic using a more recent source. --Jwoodly (talk) 19:21, 4 December 2020 (UTC)

Suggested change # 5: Proposed addition to Amyloidosis - Heart section.

 * Proposed Addition: Cardiac amyloidosis can present as symptoms of heart failure including shortness of breath, fatigue, and edema. As cardiac amyloidosis progresses, the amyloid deposition can affect the heart’s ability to pump and fill blood as well as its ability to maintain normal rhythm, which leads to worsening heart function and decline in people’s quality of life. Jan2020-med2024 (talk) 19:34, 4 December 2020 (UTC)

Suggested change # 6: Proposed addition to Amyloidosis section.

 * Proposed Addition: We propose to add to the section called ‘Research’ by adding the following sentence at the end: Research into treatments for ATTR amyloidosis have compared liver transplantation, oral drugs that stabilize the misfolding protein (including tafamidis and diflunisal), and newer therapeutic agents still being investigated (including patisiran). Based on available research, liver transplant remains the most effective treatment option for advanced ATTR amyloidosis, protein stabilizing drugs may slow disease progression but were insufficient to justify delay of liver transplant, and newer agents such as patisiran require additional studies.

Jan2020-med2024 (talk) 19:42, 4 December 2020 (UTC)

Suggested change # 7: Proposed addition to Amyloidosis section.
Original: “The three most common forms of amyloidosis are AL, AA, and ATTR amyloidoses. The median age at diagnosis is 64.[8]

In the western hemisphere, AL is the most prevalent, comprising 90% of cases.[14] In the United States it is estimated that there are 1,275 to 3,200 new cases of AL amyloidoses a year."

Changes: Amyloidosis has a combined estimated prevalence of 30 per 100,000 persons with the three most common forms being AL, ATTR, and AA. The median age at diagnosis is 64.

AL has the highest incidence at approximately 12 cases per million persons per year and an estimated prevalence of 30,000 to 45,000 cases in the US and European Union.

Rationale for proposed change: I changed the first sentence to include the combined prevalence of all types of amyloidosis. This is a good statistic to provide as it gives the reader an idea of how rare amyloidosis is. Also, I rearranged the order of the last two types of amyloidosis and placed ATTR before AA. This is important because it organizes the types of amyloidosis from most to least common and reflects the current understanding that AA has become rarer than the first two types due to advancements in treating chronic infectious diseases. The information for both changes come from two review articles published within the past 3 years from JAMA and Current Medical Research and Opinion, two highly reputable journals.

Next, I changed the two sentences about AL amyloidosis. The first sentence’s statistic regarding “90% of cases” was unfounded in the cited source. Furthermore, they provided an outdated statistic/source from 1997 for the incidence in the second sentence. I replaced these two sentences with a sentence that provided the prevalence and incidence from reputable sources updated within the past 3 years. The information for this sentence change comes from JAMA and Current Medical Research and Opinion. Jlowe24 (talk) 22:35, 4 December 2020 (UTC)

 Suggested Change #15 

Original: Outcomes in a person with AA amyloidosis depend on the underlying disease and correlate with the concentration of serum amyloid A protein.

Suggested Change: Outcomes in a person with AA amyloidosis depend on the underlying disease, organ(s) affected, and correlate with the concentration of serum amyloid A protein.

Rationale: The updated reference helps to provide prognosis context in a more broad sense, as the original reference was focused on GI amyloidosis. This updated reference allows for the most recent prognosis summary for amyloidosis from a reputable source. It also emphasizes how prognosis can be greatly influenced by which organ(s) is affected.

Gajsiv (talk) 23:55, 19 November 2021 (UTC)

 Suggested Change #16 

Original: People with ATTR have a better prognosis and may survive for over a decade.

Suggested Change: People with ATTR, mATTR and wATTR have a better prognosis when compared to people with AL and may survive for over a decade. Survival time is not associated with gender or age, however, some measures of reduced heart function are associated with a shorter survival time.

Rationale: The current sentence is incomplete as it is missing the context of a comparison group. Simply stating that people with ATTR have a better prognosis does not provide useful information unless it is compared to a different subtype of amyloidosis. To correct this we have added more information on subtypes and a comparison group to provide the needed context.

Biopsy wording
"rectal salivary gland biopsy"

Looks like a missing or. S C Cheese (talk) 15:59, 22 May 2021 (UTC)

Queen's University Student Editing Initiative 2021
Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. MohamedGemae (talk) 20:27, 15 November 2021 (UTC)

Suggested Change #1:


 * Original: Chemotherapy and steroids, with melphalan plus dexamethasone, is mainstay treatment in AL people not eligible for transplant.[19]
 * Suggested change: Chemotherapy treatment including cyclophosphamide-bortezomib-dexamethasone is currently the mainstay treatment for people with AL Amyloidosis not eligible for transplant MohamedGemae (talk) 20:27, 15 November 2021 (UTC)
 * Feedback: This edit looks great. When you make your edit be sure to add the citation immediately after the punctuation like this. JenOttawa (talk) 13:12, 19 November 2021 (UTC)

Suggested Change #2:


 * Original: There are about 30 different types of amyloidosis, each due to a specific protein misfolding.[5] Some are genetic while others are acquired.[3] They are grouped into localized forms, and systemic ones.[2]
 * Suggested Change: To date, there are about 36 different types of amyloidosis, each due to a specific protein misfolding. Within these 36 proteins, 19 are grouped into localized forms, 14 are grouped as systemic forms, and 3 proteins can identify as either.[2] These proteins can become irregular due to genetic effects, as well as through acquired environmental factors.[2] MattKuchtaruk (talk) 23:01, 15 November 2021 (UTC)
 * Feedback: This suggestion looks good. I would remove the use of "To date". People can read the citation to see the time frame but do not know when you added this information. "There are about 36 different types of amyloidosis, each due to a specific protein misfolding. " is sufficient.JenOttawa (talk) 13:12, 19 November 2021 (UTC)

Suggested Change #3:


 * Original: Diagnosis is confirmed by tissue biopsy.
 * Suggested Change: Amyloidosis is typically diagnosed through tissue biopsy, with the exception of cardiac transthyretin amyloidosis, which can be diagnosed using scintigraphic imaging if stringent criteria are met.
 * Rationale: The current version of the Wikipedia article suggests that tissue biopsy is required to confirm the diagnosis of all amyloidosis subtypes. The proposed change will include the noninvasive diagnosis of cardiac transthyretin amyloidosis using scintigraphic imaging, an exception that is an important consideration for patients and healthcare providers.KShearer17 (talk) 22:02, 17 November 2021 (UTC)
 * Feedback: This edit looks excellent and great to correct this error of omission in the article. When you are making the actual edit, please include the citation after the punctuation like this: "Amyloidosis is typically diagnosed through tissue biopsy, ".JenOttawa (talk) 13:12, 19 November 2021 (UTC)

Suggested Change #4: proposed addition to Pathogenesis section


 * Proposed addition: For example, in ATTR amyloidosis the fibrils originate from TTR. In AL amyloidosis, the misfolded protein originates from an immunoglobulin heavy or light chain fragment that can aggregate in any organ except the central nervous system.
 * Rationale: The pathogenesis section does not currently refer to the most common types of amyloidosis or which systems are most commonly affected. With the additional lines, the two most common types are introduced, giving a general description of affected systems. Tiffany.dickinson (talk) 00:18, 18 November 2021 (UTC)
 * Feedback: I am assuming AL and ATTR are defined earlier in the article? When you are making the actual edit, please include the citation after the punctuation like this: and in ATTR amyloidosis, the heart is most commonly involved. JenOttawa (talk) 13:29, 19 November 2021 (UTC

Suggested Change #5: "Diagnosis" section, "Classification" heading. As of 2010, 27 human and 9 animal fibril proteins were classified, along with 8 inclusion bodies.
 * Original:The names of amyloids usually start with the letter "A". Here is a brief description of the more common types of amyloid:[medical citation needed]


 * Suggested change: All amyloid fibril proteins start with the letter "A" followed by the protein suffix (and any applicable specification). See below for a list of amyloid fibril proteins which have been found in humans:

20ogk1 (talk) 03:33, 18 November 2021 (UTC)
 * Feedback: Looks great! Please reach out it you need help editing the table in the article. Great improvement suggestion!JenOttawa (talk) 13:29, 19 November 2021 (UTC)

Suggested Change #6:
 * Original: Senile amyloidosis resulting from deposition of normal transthyretin, mainly in the heart, is found in 10–36% of people over 80.
 * Suggested Change: Wild-type transthyretin (ATTR) amyloidosis is being increasingly identified in the elderly, and is found in a quarter of elderly at postmortem. ATTR is found in 13-19% of people experiencing heart failure with preserved ejection fraction, making it a very common form of systemic amyloidosis.
 * Rationale: The previous information on ATTR is from 2008, thus the statistics needed to reflect current findings (proposed information is from 2021). In this article ATTR amyloidosis is referred to many times, but Senile amyloidosis is not. ATTR is often referred to as Senile amyloidosis, but it can be misleading for the reader, thus I updated this section to use the terminology (ATTR) that is referenced throughout the wikipedia article. 13mjs21 (talk) 13:45, 18 November 2021 (UTC)


 * Feedback:This looks like a good edit. Can you shorten your sentence a little? For example, it may not be necessary to write "is being increasingly identified in the elderly," if you are then adding that it is found in 1/4 of elderly people at postmortem. Either way is fine though if you feel that it is important to include. Very minor edit: Please do not leave a space between your punctuation (in this case the period) and the citation. "Your citation should look like this: making it a very common form of systemic amyloidosis. "JenOttawa (talk) 13:29, 19 November 2021 (UTC)

Suggested Change #7: Diflunisal binds to misfolded mutant TTR protein to prevent its buildup, like how tafamidis works. Low-certainty evidence indicates that it reduces worsening of peripheral neuropathy and disability from disease progression.ref name=":5">
 * Original: However, newer therapies including diflunisal, an anti-inflammatory drug, and inotersen and patisiran, drugs which prevent misfolded protein formation, have shown early promises in slowing disease progression.[29] The latter two drugs have shown their benefit in neurological impairment scores and quality of life measures.[29] However, their role in cardiac ATTR amyloidosis is still being investigated.[29]
 * Suggested Change: New drug therapies include diflunisal, inotersen, and patisiran.

Inotersen blocks gene expression of both wild-type and mutant TTR, reducing amyloid precursor. Moderate-certainty evidence suggests that it reduces worsening of peripheral neuropathy. Long-term efficacy and safety of inotersen use in people with mutant TTR-related amyloidosis is still being evaluated in a phase-3 clinical trial as of 2021. Both diflunisal and inotersen may also reduce decreases in quality-of-life, though the evidence for this effect is yet unclear. For people with cardiac ATTR the effect of inotersen use is inconclusive and requires further investigation.

Patisiran functions similarly to inotersen. Moderate-certainty evidence suggests that patisiran reduces worsening of peripheral neuropathy and disability from disease progression. Additionally, low-certainty evidence suggests that patisiran reduces decreases in quality-of-life and slightly reduces the rate of adverse events versus placebo. There is no evidence of an effect on mortality rate. A review of early data from use of patisiran in people with variant cardiac ATTR suggests that it may reduce mortality and hospitalization, however this is still being investigated and requires. Jmo7865 (talk) 18:27, 18 November 2021 (UTC)


 * Feedback: This looks like a good edit. Be sure that you add the citations properly in the actual article. I addd them for you. Did the last sentence get cut off? I just noticed it ends with "and requires...". I like how you used the secondary sources to add background information and also evidence supporting efficacy. I re-addedJenOttawa (talk) 13:29, 19 November 2021 (UTC)

Suggested Change #8: Amyloidosis Treatment section

Original: In 2018, inotersen was approved by the European Medicines Agency to treat polyneuropathy in adults with hereditary transthyretin amyloidosis.

Suggested Change: In 2018, inotersen was approved by the European Medicines Agency to treat polyneuropathy in adult patients with hereditary transthyretin amyloidosis. It has since been approved for use in Canada, the European Union and in the USA. Rationale for proposed change: The current status of geographical approval of inotersen use for amyloidosis has been expanded beyond Europe and is now approved in Canada and the U.S. Thus, the current sentence requires an updated source reflecting the most recent information available about where inotersen is approved for use. Additionally, a link to details on inotersen was added for readers interested in learning about the drug. 14sks13 (talk) 23:14, 18 November 2021 (UTC)


 * Feedback: This looks good. I like the use of Wikilinks for inotersen. Very minor edit: Please do not leave a space between your punctuation (in this case the period) and the citation. Your citation should look like this: Canada, the European Union and in the USA.  For some reason, the citation tool did not auto-generate all the information into the citation template when you pasted the website. I have added it in.  Please use this version of your references:     JenOttawa (talk) 13:29, 19 November 2021 (UTC)

Suggested Change #9: Treatment of Secondary Amyloidosis


 * Original: Eprodisate theoretically slowed renal impairment by inhibiting polymerization of amyloid fibrils, however after a negative phase three trial, it seems unlikely to be effective.


 * Suggested Change: In people who have inflammation caused by AA amyloidosis, tumour necrosis factor (TNF)-alpha inhibitors such as infliximab and etanercept are used for an average duration of 20 months. If TNF-alpha inhibitors are not effective, Interleukin-1 inhibitors (e.g. anakinra, canakinumab, rilonacept) and interleukin-6 inhibitors (e.g. tocilizumab) may be considered.

18lar2 (talk) 00:03, 19 November 2021 (UTC)
 * Reason for change: Original source was a randomized control trial, new source is a clinical guideline with more recent recommendations from experts in the field.


 * Feedback: Great edit to replace a non Identifying reliable sources (medicine) source with a stronger secondary source. I realize the editing talk pages is a little different as they do not have the visual editor option. I re-added your citation using the proper formatting. The only other (very) minor edit was to move the location of the citation to be immediately after the punctuation. JenOttawa (talk) 13:29, 19 November 2021 (UTC)

Suggested Change #10: Pathogenesis Section

It is suggested to add the following two lines to the Pathogenesis section, after the first sentence of the last paragraph: The beta-sheet form of amyloid is proteolysis-resistant, meaning it can not be degraded or broken down. As a result, amyloid deposits into the body’s extracellular space. RResearcher (talk) 03:06, 19 November 2021 (UTC)


 * Feedback: This looks great. For some reason your second reference is not coming up. Do you want to re-use your first reference or are you using two? I can help adjust if you are re-using it. JenOttawa (talk) 13:29, 19 November 2021 (UTC)
 * It seems to be fixed and you have added it correctly. Sorry, it may have been my computer!JenOttawa (talk) 13:52, 19 November 2021 (UTC)

Suggested Change #11: Signs and Symptoms Section

Suggested change is to add these sentences to the liver subsection of Signs and Symptoms: Accumulation of amyloid proteins in the gastrointestinal system may be caused by a wide range of amyloid disorders and have different presentations depending on the degree of organ involvement. Potential symptoms include weight loss, diarrhea, abdominal pain, heartburn (gastrointestinal reflux), and GI bleeding. Amyloidosis may also affect accessory digestive organs including the liver, and may present with jaundice, fatty stool, anorexia, fluid buildup in the abdomen, and spleen enlargement. Helenlin315 (talk) 04:10, 19 November 2021 (UTC)


 * Feedback: Your edit looks great. If all this info came from the same source it would be best to re-use the source after each sentence. This is how Wikipedia is a little different compared to academia. I added a citation needed tag as an example. You can click "cite" then rather than adding a new citation, look for the "re-use" tab. It is also more difficult to be editing on talk pages as they do not have the 'visual' editor tool. If you want to practice re-adding your citation in your sandbox that is fine! JenOttawa (talk) 13:29, 19 November 2021 (UTC)

Suggested Change #12:


 * Original: In the west, AA is more likely to occur from autoimmune inflammatory states.[7] The most common causes of AA amyloidosis in the West are rheumatoid arthritis, inflammatory bowel disease, psoriasis, and familial Mediterranean fever.
 * Suggested change: AA amyloidosis is caused by an increase in extracellular deposition of serum amyloid A (SAA) protein. SAA protein levels can rise in both direct and indirect manners, through infection, inflammation, and malignancies. The most common causes of AA amyloidosis in the West are rheumatoid arthritis, inflammatory bowel disease, psoriasis, and familial Mediterranean fever.[7] 16sa48 (talk) 16:32, 19 November 2021 (UTC)


 * Feedback: This looks good. JenOttawa (talk) 00:46, 22 November 2021 (UTC)

Suggested change #13 : Signs & Symptoms - Brain
 * Current sentence: Adding in addition to the currently written section.
 * Proposed change: It is important to note that neuropathic presentation can depend on etiological mutations underlying amyloidosis . People with amyloidosis may experience dysfunction in various organ systems depending on which nerves are impacted . For example, peripheral neuropathy can cause erectile dysfunction, incontinence and constipation, pupillary dysfunction, and sensory loss . In more serious cases, amyloidosis of the brain can cause life-threatening arrhythmias, cardiac failure, malnutrition, infection, or death.

Rationale for proposed change: The suggested additions will provide a more comprehensive understanding of the signs and symptoms of amyloidosis in the nervous system, specifically emphasizing the widespread, systemic impacts of amyloidosis neuropathy. The current “Brain” section does not do well in expanding upon the potential signs of symptoms of brain amyloidosis or acknowledge the peripheral impacts of neuropathy.


 * Hi, in general we avoid passing judgment on the 'importance' of a piece of evidence. I would suggest changing the above to read: It is important to note that neuropathic presentation can depend on etiological mutations underlying amyloidosis. Please note that the reference goes immediately after the punctuation. Are there any wikilinks that can be added to life-threatening arrhythmias, cardiac failure, malnutrition, infection, or death? Note: we usually only wikilink the first use of the word in the article.~

Suggested Change #14 Current Sentence: Amyloid deposition in the kidneys can cause nephrotic syndrome, which results from a reduction in the kidney's ability to filter and hold on to proteins. The nephrotic syndrome occurs with or without elevations in creatinine and blood urea concentration, two biochemical markers of kidney injury. In AA amyloidosis, the kidneys are involved in 91–96% of people, symptoms ranging from protein in the urine to nephrotic syndrome and rarely chronic kidney disease. [1] Lewis J.B., & Neilson E.G. (2018). Glomerular diseases. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J(Eds.), Harrison's Principles of Internal Medicine, 20e. McGraw Hill. https://accessmedicine-mhmedical-com.proxy.queensu.ca/content.aspx?bookid=2129&sectionid=192281295 [2] U.S. Department of Health and Human Services. (n.d.). Amyloidosis & Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved November 19, 2021, from https://www.niddk.nih.gov/health-information/kidney-disease/amyloidosis. Ameliaboughn (talk) 22:19, 19 November 2021 (UTC)
 * Proposed Change: Amyloidosis deposits often affect the blood vessels and mesangial regions of the kidneys, affecting the organ’s ability to filter and excrete waste.[2] This can lead to high levels of protein in the urine (proteinuria) and nephrotic syndrome.[2] Several types of amyloidosis, including the AL and AA types, are associated with nephrotic syndrome. 20% and 40-60% of people with AL and AA respectively progress to dialysis.
 * Rationale for proposed change: The first sentence as the section is now doesn’t clearly explain why and how amyloidosis can lead to nephrotic syndrome. Our proposed replacement (first two proposed sentences) will lay out this connection more clearly. The third proposed sentence explains which types of amyloidosis are most commonly associated with the kidneys, and complements existing information about AA amyloidosis and kidney involvement. We removed the last sentence because the source did not adhere to MEDRS criteria and we couldn't find this information elsewhere.
 * Area of Controversy: We identified no controversies in this addition.
 * Critique of Source: The first source is an internal medicine textbook. As a book, one weakness of this source is that it isn’t the most up to date. It was last updated in 2018, but given the length of the publication process its information is not as current as what might come from a recently published review in a journal. The second source supplemented the first source because, to be honest, we couldn’t find much in the academic literature that the average person would have any interest in when it comes to amyloidosis. Most of the information in the academic literature was about advanced diagnostic methods and various genetic markers. We turned to the NIH to provide more relevant information. A weakness of this source is that it is not a formal academic review and therefore may not meet the MEDRS guidelines.
 * Feedback: Is it possible to wikilink any of the technical terms (if they are not already linked earlier)? I realize adding references to the talk pages is harder as it does not use the visual editor. If you need help adding references when editing the article live please reach out. Do your text books have page #s where you accessed the info? If possible we try to include this on Wikipedia in the citation. I have adjusted your references on this talk page (above). NOTE: I see you used a queen's link for the Harrison's text book. Please adjust (see my edit to your citation, above) Great work so far!JenOttawa (talk) 00:46, 22 November 2021 (UTC)

 Suggested Change #15 

Original: Outcomes in a person with AA amyloidosis depend on the underlying disease and correlate with the concentration of serum amyloid A protein.

Suggested Change: Outcomes in a person with AA amyloidosis depend on the underlying disease, organ(s) affected, and correlate with the concentration of serum amyloid A protein.

Rationale: The updated reference helps to provide prognosis context in a more broad sense, as the original reference was focused on GI amyloidosis. This updated reference allows for the most recent prognosis summary for amyloidosis from a reputable source. It also emphasizes how prognosis can be greatly influenced by which organ(s) is affected.

Gajsiv (talk) 00:03, 20 November 2021 (UTC)
 * Feedback: Thanks This edit looks great. JenOttawa (talk) 00:56, 29 November 2021 (UTC)

 Suggested Change #16 

Original: People with ATTR have a better prognosis and may survive for over a decade.

Suggested Change: People with ATTR, mATTR and wATTR have a better prognosis when compared to people with AL and may survive for over a decade. Survival time is not associated with gender or age, however, some measures of reduced heart function are associated with a shorter survival time.

Rationale: The current sentence is incomplete as it is missing the context of a comparison group. Simply stating that people with ATTR have a better prognosis does not provide useful information unless it is compared to a different subtype of amyloidosis. To correct this we have added more information on subtypes and a comparison group to provide the needed context.Gpauliqmed (talk) 00:19, 20 November 2021 (UTC)
 * Feedback: Thanks for sharing this are all of these acronyms commonly used and defined earlier in the next? Nice use of your citation!JenOttawa (talk) 00:55, 29 November 2021 (UTC)

§ Diagnosis: Classification — Qualm
Hello,

I am curious why, in the table of amyloidosis classifications, the central nervous system (CNS) is linked at every mention? This is surely superfluous, as other organs or their systems in the table are not linked.

Can this be removed? A surfeit of links can be distracting while trying to read. Zyploc (talk) 19:50, 24 October 2023 (UTC)

Intracerebral hemorrhage risk factor and brain-related amyloidoses
Amyloidosis is listed on the intracerebral hemorrhage page as a big risk factor for that condition, yet the amyloidosis page makes no mention of this. There is a "Organ-limited amyloidosis" subsection of the "Amyloidosis" infobox at the bottom of the page, but I wonder if there is somewhere within the main article to note the risk factor connection to intracerebral hemorrhage?

I propose to add a "Brain" section under the "Signs and symptoms" section of the amyloidosis page that could indicate the brain hemorrhage connection as well as noting cerebral amyloid angiopathy (CAA) which appears in the brain subsection of the amyloidosis infobox. The following statement appears on the CAA page: "The amyloid material is only found in the brain and as such the disease is not related to other forms of amyloidosis." That disclaimer, I believe, also applies to the other conditions noted in the infobox: Alzheimer's disease and Familial amyloid neuropathy. SteveChervitzTrutane (talk) 09:08, 7 May 2024 (UTC)

DELETE PURPURA IMAGE
The purpura image on the landing page is not indicative of the presenting symptom disease state for 99.99% of amyloidosis victims. There is a constellation of symptoms which include bruising. The extreme nature of this image diminishes the plethora of other critically important early symptoms such as carpal tunnel. I believe the landing page imagery should be changed to an updated slide of early warning symptoms which may include purpura. Seattle Amyloidosis Group (talk) 17:12, 13 May 2024 (UTC)


 * Noting for the record that the main image for this page has been changed to use an infographic from the Amyloidosis Awareness Booklet published by the National Amyloidosis Support Groups (ASG, amyloidosissupport.org). The media page for this infographic (which I uploaded) states "Fairman Studios, LLC." as the copyright owner of the image and claims fair use. However, the ASG has since informed me that ASG actually owns all the images appearing in their booklet. If they are willing to give the image a CreativeCommons license, it could be added to Wikimedia Commons and used in higher resolution on the page.
 * Regarding the former facial purpura image:
 * It still appears on the Amyloidosis page of 14 non-English speaking Wikipedias. Those other pages could be updated as well using language-specific versions of the infographic.
 * This facial purpura image could be added to the Wikipedia article for purpura, noting that it is an extreme example and rarely occurs (as stated on its media page).
 * SteveChervitzTrutane (talk) 07:31, 8 July 2024 (UTC)