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Systemic amyloidosis: getting to the heart of the matter.

Just 10–15 years ago, amyloidosis was poorly understood, difficult to diagnose and type, and was widely thought to be inexorable. Specialist clinical services were not available and many patients did not receive any disease-modifying treatment. To the histopathologist, the inert appearance of amyloid deposits without any accompanying tissue reaction seemed to provide further evidence of their irreversibility. Patients with systemic AL (monoclonal immunoglobulin) amyloidosis, the most common and serious type, usually died within 2 years of diagnosis, and often within 6 months when the heart was involved. The symposium in this issue of the journal provides an update on systemic amyloidosis, with a focus on its pathogenesis and clinical management. Cardiac and renal amyloidosis are addressed specifically, given the frequency with which these two vital organ systems are involved.