@article{discovery10052925,
          number = {3},
            year = {2017},
           title = {Changing epidemiology of AA amyloidosis: clinical observations over 25 years at a single national referral centre},
       publisher = {TAYLOR \& FRANCIS LTD},
         journal = {Amyloid: The Journal of Protein Folding Disorders},
          volume = {24},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
           pages = {162--166},
             url = {https://doi.org/10.1080/13506129.2017.1342235},
          author = {Lane, T and Pinney, JH and Gilbertson, JA and Hutt, DF and Rowczenio, DM and Mahmood, S and Sachchithanantham, S and Fontana, M and Youngstein, T and Quarta, CC and Wechalekar, AD and Gillmore, JD and Hawkins, PN and Lachmann, HJ},
            issn = {1744-2818},
        abstract = {Objective: Systemic AA amyloidosis is a serious complication of chronic inflammation; however, there are relatively few published data on its incidence. We investigated the changing epidemiology of AA amyloidosis over a 25-year period at a single national referral centre. //

Methods: We conducted a retrospective study of all patients diagnosed with AA amyloidosis who had attended the centre between 1990 and 2014 inclusive. Six hundred and twenty-five patients were studied in three cohorts: C1: 1990-1997; C2: 1998-2006; C3: 2007-2014. //

Results: Mean age at presentation increased from 46 in C1 to 56 in C3 (p {\ensuremath{<}} .0001). The proportion of South Asian patients increased from 4\% in C1 to 17\% in C3 (p = .0006). Comparison of underlying diseases between C1 and C3 revealed a reduction in patients with juvenile idiopathic arthritis from 25\% to 2\% (p {\ensuremath{<}} .0001), but an increase in patients with chronic infection due to intravenous recreational drug use from 1\% to 13\% (p {\ensuremath{<}} .0001), and uncharacterized inflammatory disorders from 10\% to 27\% (p {\ensuremath{<}}.0001). More patients were in end-stage renal failure at presentation in C3 (29\%) than C1 (15\%) (p = .0028). Median age at death was later in C3 (62 years) than C1 (54 years) (p = .0012). //

Conclusion: These data suggest both falling incidence and better outcome in AA amyloidosis over a quarter of a century, reflecting advances in therapeutics and overall management of complex chronic disease in an ageing population. AA amyloidosis of uncertain aetiology presents an emerging major problem. Newer techniques such as next-generation sequencing may aid diagnosis and effective treatment, thereby improving overall survival.},
        keywords = {AA amyloidosis, systemic amyloidosis, epidemiology, inflammation, renal failure}
}