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Intestinal amyloidosis: treatment
Last reviewed: 23.04.2024
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In amyloidosis, including amyloidosis of the intestine, a complex of medications is recommended that have an effect on the main links in the pathogenesis of the disease.
In order to influence the intracellular synthesis of amyloid protein, 4-aminoquinoline derivatives (chloroquine, delagil, plaquenil), corticosteroid hormones in small and medium doses, colchicine, immunostimulants: T- and B-activin, levamisole, are prescribed. The formation of amyloid is inhibited by thiol compounds (glutathione, unitiol), which is confirmed by experimental studies. The compounds of fibrillar protein amyloid with other tissue and plasma components are prevented by antihistamines. Finally, since the fact of amyloid resorption is established, the agents stimulating resorption of amyloid are effective: ascorbic acid, anabolic hormones, liver preparations. In secondary amyloidosis, the main disease should first be treated.
In recent years, there have been reports of successful treatment of amyloidosis with periodic disease and rheumatoid arthritis with colchicine. The effectiveness of therapy with this drug has been confirmed by the study of repeated biopsy specimens of the rectal mucosa.
A case of recovery from amyloidosis of the intestine and stomach (type AA) complicating chronic ulcerative colitis is described in the treatment with salazopyrin (3 g / day) and prednisolone (30 mg / day) in combination with blood transfusions.
Data on the successful use (improvement of endoscopic and histological indices) of dimethyl sulfoxide and prednisolone in gastrointestinal amyloidosis (type AA) in a 37-year-old man with Still's disease have been obtained.
However, domestic researchers to apply dimethyl sulfoxide in amyloidosis are reserved, preferring colchicine and its analogues.
Primary amyloidosis virtually does not lend itself to therapeutic effects. Cytostatics in combination with prednisolone lead only to subjective improvement.
The treatment of any form of amyloidosis of the intestine provides for the inclusion in the complex of therapeutic measures of agents affecting diarrhea and replenishing the deficiency of a number of substances that have resulted from a violation of absorption.
Prevention of secondary amyloidosis is the prevention of chronic purulent-inflammatory, autoimmune and neoplastic diseases from the paraproteinemic leukemia group.
The prognosis for amyloidosis of the intestine is unfavorable, especially when there is a syndrome of impaired absorption, as well as such formidable complications as bleeding and perforation of the intestine. Involvement in the pathological process of the kidneys burdens the prognosis. However, the possibility of resorption of amyloid in secondary amyloidosis on the background of treatment with colchicine makes a prognosis for this form of the disease more favorable.
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