{"id":7634,"date":"2026-01-30T15:15:00","date_gmt":"2026-01-30T14:15:00","guid":{"rendered":"https:\/\/reseau-amylose.org\/jesuissoignant\/?page_id=7634"},"modified":"2026-08-25T20:40:15","modified_gmt":"2026-08-25T18:40:15","slug":"professionnels-chirurgien-main-orthopediste","status":"publish","type":"page","link":"https:\/\/reseau-amylose.org\/jesuissoignant\/professionnels-chirurgien-main-orthopediste\/","title":{"rendered":"Pour le chirurgien de la main"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7634\" class=\"elementor elementor-7634\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0efb861 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0efb861\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-abcb470\" data-id=\"abcb470\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-02cd39d elementor-widget elementor-widget-heading\" data-id=\"02cd39d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">R'EPOF - Les atteintes rhumatologiques dans le diagnostic pr\u00e9coce de l'amylose<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9e3cfbd elementor-widget elementor-widget-heading\" data-id=\"9e3cfbd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">TIC-TAC, changeons de TAC-TIC et passons du TACoTAC<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cc2f7b1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cc2f7b1\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b472b71\" data-id=\"b472b71\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8695cdf elementor-widget elementor-widget-text-editor\" data-id=\"8695cdf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><em>En tant que chirurgien de la main ou orthop\u00e9diste, vous op\u00e9rez d\u00e9j\u00e0 les patients porteurs des atteintes les plus \u00e9vocatrices d&rsquo;amylose cardiaque : canal carpien, canal lombaire, arthroplastie de hanche ou de genou. Un pr\u00e9l\u00e8vement biopsique opportuniste pendant ces interventions, rapide et sans morbidit\u00e9 suppl\u00e9mentaire, peut permettre un diagnostic pr\u00e9coce \u2014 5 \u00e0 9 ans avant l&rsquo;atteinte cardiaque.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2143690 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2143690\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f9cf59c\" data-id=\"f9cf59c\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b928ab3 elementor-widget elementor-widget-heading\" data-id=\"b928ab3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Points cl\u00e9s pour les professionnels de sant\u00e9<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ec3f098 elementor-widget elementor-widget-text-editor\" data-id=\"ec3f098\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>Le canal carpien bilat\u00e9ral pr\u00e9c\u00e8de l&rsquo;atteinte cardiaque de 5 \u00e0 9 ans dans l&rsquo;ATTRwt (pr\u00e9valence 40-60 %).<\/li><li>Toute intervention ost\u00e9oarticulaire (canal carpien, arthroscopie, arthroplastie de hanche\/genou, d\u00e9compression lombaire) est une occasion de pr\u00e9l\u00e8vement biopsique opportuniste, rapide (&lt;2 min) et sans morbidit\u00e9 suppl\u00e9mentaire.<\/li><li>Seuils de biopsie : homme &gt; 60 ans d\u00e8s 1 facteur de risque ; femme &gt; 60 ans \u00e0 partir de 2 ; canal carpien bilat\u00e9ral isol\u00e9 &gt; 70 ans, syst\u00e9matique.<\/li><li>Toujours pr\u00e9lever 2 \u00e9chantillons (formol + tissu frais congel\u00e9) et contacter l&rsquo;anatomopathologie avant l&rsquo;intervention.<\/li><li>En cas de signes EPOF, adresser en cardiologie en priorit\u00e9, avant toute chirurgie.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5f0ca5f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5f0ca5f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d00c295\" data-id=\"d00c295\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e258f6 elementor-widget elementor-widget-heading\" data-id=\"3e258f6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Qu'est ce que l'amylose ? <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-08201fc elementor-widget elementor-widget-text-editor\" data-id=\"08201fc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"1519\" data-end=\"1652\">L\u2019<strong data-start=\"3018\" data-end=\"3029\">amylose<\/strong> est une maladie rare caract\u00e9ris\u00e9e par le d\u00e9p\u00f4t anormal de prot\u00e9ines amylo\u00efdes dans diff\u00e9rents organes, dont le c\u0153ur, les reins, le syst\u00e8me nerveux et le tissu musculo-squelettique.<br data-start=\"3210\" data-end=\"3213\" \/>Ces d\u00e9p\u00f4ts provoquent des atteintes progressives qui peuvent \u00eatre graves, mais <strong data-start=\"3292\" data-end=\"3357\">le diagnostic pr\u00e9coce am\u00e9liore significativement le pronostic<\/strong>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9992502 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"9992502\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/pour-le-cardiologue\/le-point-sur-les-amyloses\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Pour en savoir plus sur les amyloses - Cliquez ici<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d43bff3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d43bff3\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-80cadda\" data-id=\"80cadda\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-804fc15 elementor-widget elementor-widget-heading\" data-id=\"804fc15\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quelles amyloses concernent l'orthop\u00e9diste ?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9be7596 elementor-widget elementor-widget-text-editor\" data-id=\"9be7596\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Les amyloses cardiaques (AC) sont souvent mal diagnostiqu\u00e9es. Elles sont secondaires \u00e0 une anomalie conformationnelle prot\u00e9ique qui entra\u00eene une accumulation extracellulaire de fibrilles amylo\u00efdes insolubles dans certains organes, y entra\u00eenant une dysfonction. Les organes cibles et le sous-type de l&rsquo;amylose sont d\u00e9termin\u00e9s par la prot\u00e9ine causale. Les organes infiltr\u00e9s sont le c\u0153ur, le rein, le foie\u2026 mais aussi les t\u00e9guments (synoviale), les articulations, le syst\u00e8me gastro-intestinal et nerveux.<\/p><p><strong>L&rsquo;amylose \u00e0 transthyr\u00e9tine (ATTR)<\/strong><\/p><ul><li>Forme sauvage (la plus fr\u00e9quente en orthop\u00e9die) : homme &gt; 50 ans et femme &gt; 60 ans.<\/li><li>Forme h\u00e9r\u00e9ditaire : mutation du g\u00e8ne TTR, plus rare.<\/li><\/ul><p><strong>L&rsquo;amylose \u00e0 cha\u00eenes l\u00e9g\u00e8res d&rsquo;immunoglobulines (AL) : <\/strong>moins fr\u00e9quente mais urgence th\u00e9rapeutique, biopsie indispensable pour typer.<\/p><p data-start=\"1519\" data-end=\"1652\">Certaines manifestations musculo-squelettiques sont particuli\u00e8rement fr\u00e9quentes chez les patients atteints d\u2019<strong data-start=\"1628\" data-end=\"1639\">amylose<\/strong>, notamment :<\/p><ul><li data-start=\"1656\" data-end=\"1738\"><strong data-start=\"1656\" data-end=\"1685\">Syndrome du canal carpien<\/strong>\u00a0<\/li><li data-start=\"1656\" data-end=\"1738\"><strong data-start=\"1741\" data-end=\"1760\">Doigt \u00e0 ressaut<\/strong>\u00a0<\/li><li data-start=\"1656\" data-end=\"1738\"><strong data-start=\"1833\" data-end=\"1852\">Arthrose rapide<\/strong>\u00a0<\/li><li data-start=\"1656\" data-end=\"1738\"><strong data-start=\"1924\" data-end=\"1948\">Ruptures tendineuses<\/strong>\u00a0<\/li><li data-start=\"1656\" data-end=\"1738\"><strong data-start=\"2064\" data-end=\"2093\">Syndrome du canal r\u00e9tr\u00e9ci<\/strong>\u00a0<\/li><li data-start=\"1656\" data-end=\"1738\"><strong data-start=\"2136\" data-end=\"2162\">Proth\u00e8ses articulaires<\/strong> : hanches, genoux ou \u00e9paules\u00a0<\/li><\/ul><p data-start=\"2258\" data-end=\"2428\">Ces signes doivent alerter lorsque leur pr\u00e9sentation est <strong data-start=\"2315\" data-end=\"2389\">bilat\u00e9rale, r\u00e9currente, ou associ\u00e9e \u00e0 d\u2019autres sympt\u00f4mes syst\u00e9matiques<\/strong> : surdit\u00e9 ou signes d&rsquo;insuffisance cardaique <span style=\"color: #ff0000\"><strong>EPOF<\/strong><\/span> (<strong><span style=\"color: #ff0000\">E<\/span><\/strong>ssoufflement, <span style=\"color: #ff0000\"><strong>P<\/strong><\/span>rise de poids, <span style=\"color: #ff0000\"><strong>O<\/strong><\/span>ed\u00e8mes et <span style=\"color: #ff0000\"><strong>F<\/strong><\/span>atigue).\u00a0<\/p><p>Les atteintes musculo-squelettiques et t\u00e9gumentaires des amyloses \u00e0 ATTR h\u00e9r\u00e9ditaires ou sauvages et des amyloses AL pr\u00e9c\u00e8dent souvent de plusieurs ann\u00e9es une atteinte cardiaque s\u00e9v\u00e8re. L&rsquo;atteinte du canal carpien est tr\u00e8s fr\u00e9quente, notamment dans l&rsquo;amylose \u00e0 ATTR, avec une pr\u00e9valence autour de 50 % ; elle survient le plus souvent 5 \u00e0 7 ans avant l&rsquo;atteinte cardiaque. La r\u00e9alisation de biopsies syst\u00e9matiques de la synoviale du canal carpien chez des patients de 60 \u00e0 80 ans retrouve des d\u00e9p\u00f4ts de fibrilles amylo\u00efdes TTR dans pr\u00e8s de 20 % des cas. Dans l&rsquo;amylose AL, l&rsquo;atteinte du canal carpien est moins fr\u00e9quente (9 %).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ecf69d8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ecf69d8\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7700365\" data-id=\"7700365\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5e123b8 elementor-widget elementor-widget-heading\" data-id=\"5e123b8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Identifier les patients \u00e0 risque<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d84c1de elementor-widget elementor-widget-text-editor\" data-id=\"d84c1de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Reconna\u00eetre les premiers signes de cardiopathie amylo\u00efde et savoir la rechercher chez les patients qui consultent pour troubles musculo-squelettiques est donc essentiel pour un diagnostic pr\u00e9coce, un \u00e9l\u00e9ment cl\u00e9 du pronostic.<\/p><p><strong>Principales atteintes ost\u00e9oarticulaires associ\u00e9es \u00e0 l&rsquo;amylose :<\/strong><\/p><ul><li>Canal carpien bilat\u00e9ral \u2014 pr\u00e9valence 40-60 % dans l&rsquo;ATTRwt av\u00e9r\u00e9e ; pr\u00e9c\u00e8de le c\u0153ur de 5-9 ans (Grogan 2016, Sperry 2018).<\/li><li>Canal lombaire \u00e9troit \u2014 d\u00e9p\u00f4ts TTR retrouv\u00e9s dans ~34 % des patients op\u00e9r\u00e9s de st\u00e9nose lombaire &gt; 75 ans (Maurer 2022).<\/li><li>Canal cervical \u00e9troit.<\/li><li>Rupture de coiffe des rotateurs, rupture spontan\u00e9e de la longue portion du biceps.<\/li><li>Ruptures tendineuses spontan\u00e9es : quadriceps, tendons achill\u00e9ens.<\/li><li>Coxarthrose et gonarthrose s\u00e9v\u00e8res \u2014 proth\u00e8ses totales de hanche et genou.<\/li><li>Doigt \u00e0 ressaut et maladie de Dupuytren.<\/li><\/ul><p><strong><em>Face \u00e0 l&rsquo;une de ces atteintes chez un patient de plus de 60 ans, rechercher les facteurs de risque suivants pour d\u00e9cider d&rsquo;une biopsie.<\/em><\/strong><\/p><p><strong>Facteurs de risque cardiovasculaires pouvant d\u00e9j\u00e0 \u00eatre en lien avec une amylose cardiaque d\u00e9j\u00e0 pr\u00e9sente :<\/strong><\/p><ul><li>Fibrillation atriale (ACFA).<\/li><li>Trouble de conduction \u00b1 pacemaker.<\/li><li>\u00a0<\/li><li>Insuffisance cardiaque (signes EPOF).<\/li><\/ul><p><strong>Autres ant\u00e9c\u00e9dents associ\u00e9s \u00e0 une amylose :<\/strong><\/p><ul><li>Neuropathie p\u00e9riph\u00e9rique inexpliqu\u00e9e.<\/li><li>Troubles de l&rsquo;audition.<\/li><li>Ant\u00e9c\u00e9dent familial d&rsquo;amylose TTR h\u00e9r\u00e9ditaire.<\/li><li>Origine africaine subsaharienne (mutation ATTR Val142Ile [pV122I], pr\u00e9sente chez 3,6 % des afro-carib\u00e9ens).<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-81df44a elementor-widget elementor-widget-text-editor\" data-id=\"81df44a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>EPOF, les signes d&rsquo;insuffisance cardiaque \u00e0 rechercher \u00e0 l&rsquo;interrogatoire :<\/strong><\/p><ul><li>Essoufflement \u00e0 l&rsquo;effort ou au repos.<\/li><li>Prise de poids rapide inexpliqu\u00e9e.<\/li><li>\u0152d\u00e8mes des membres inf\u00e9rieurs.<\/li><li>Fatigue inhabituelle, malaises \u00e0 l&rsquo;orthostatisme.<\/li><\/ul><p><strong>En cas de signes EPOF : adresser en cardiologie en priorit\u00e9, avant toute chirurgie.<\/strong><\/p><p><a href=\"https:\/\/vaincrelinsuffisancecardiaque.org\/jai-epof-essoufflement-prise-poids-oedemes-fatigue\/\" target=\"_blank\" rel=\"noopener\">Pour en savoir plus sur EPOF<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9ff40e4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9ff40e4\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a6efc0b\" data-id=\"a6efc0b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-62d302b elementor-widget elementor-widget-heading\" data-id=\"62d302b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u00c0 qui r\u00e9aliser la biopsie ?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-87f9028 elementor-widget elementor-widget-text-editor\" data-id=\"87f9028\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"1519\" data-end=\"1652\">Ces manifestations rhumatologiques ne sont pas isol\u00e9es : elles peuvent \u00eatre le <strong data-start=\"2542\" data-end=\"2584\">premier indice d\u2019une amylose cardiaque<\/strong>. L\u2019accumulation de prot\u00e9ines amylo\u00efdes dans le c\u0153ur entra\u00eene progressivement une <strong data-start=\"2666\" data-end=\"2704\">insuffisance cardiaque<\/strong>, mais ce stade appara\u00eet souvent tardivement.<\/p><p data-start=\"1519\" data-end=\"1652\"><br data-start=\"2749\" data-end=\"2752\" \/>La d\u00e9tection des atteintes rhumatologiques <strong data-start=\"2795\" data-end=\"2827\">permet un diagnostic pr\u00e9coce<\/strong>, avant que <a href=\"https:\/\/vaincrelinsuffisancecardiaque.org\/jai-epof-essoufflement-prise-poids-oedemes-fatigue\/\" target=\"_blank\" rel=\"noopener\" data-wplink-edit=\"true\">les signes cardiaques EPOF<\/a> (Essoufflement, Prise de poids, Oed\u00e8me, Fatigue) ne soient pr\u00e9sents, ouvrant ainsi la voie \u00e0 une prise en charge cibl\u00e9e.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-66dbd56 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"66dbd56\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-71258f5\" data-id=\"71258f5\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2de89c5 elementor-widget elementor-widget-heading\" data-id=\"2de89c5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Comment pr\u00e9lever et que demander en anatomopathologie<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-705366f elementor-widget elementor-widget-text-editor\" data-id=\"705366f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Avant l&rsquo;intervention : <\/strong>contacter au pr\u00e9alable l&rsquo;\u00e9quipe d&rsquo;anatomopathologie pour informer de la demande de typage amylose (AL vs TTR) et v\u00e9rifier la disponibilit\u00e9 du circuit \u00ab tissu frais \u00bb (cong\u00e9lation \u00e0 -80\u00b0C ou envoi rapide). Ce contact pr\u00e9alable est indispensable, un pr\u00e9l\u00e8vement frais non anticip\u00e9 sera souvent jet\u00e9 ou mal conditionn\u00e9.<\/p><p><strong>Technique de pr\u00e9l\u00e8vement :<\/strong><\/p><p>Pr\u00e9lever la synoviale des fl\u00e9chisseurs et\/ou le ligament carpien transverse lors de la chirurgie. Le pr\u00e9l\u00e8vement peut \u00eatre r\u00e9alis\u00e9 lors de toute intervention ost\u00e9oarticulaire : lib\u00e9ration du canal carpien, arthroscopie, arthroplastie de hanche ou de genou, d\u00e9compression lombaire (ligament jaune ++).<\/p><ul><li>Fragments de 3-5 mm minimum, 2 fragments si possible.<\/li><li>\u00c9viter les zones n\u00e9crotiques ou h\u00e9morragiques.<\/li><li>En cas de canal carpien : la synoviale des fl\u00e9chisseurs est pr\u00e9f\u00e9rable au ligament carpien transverse seul, rendement diagnostique sup\u00e9rieur.<\/li><li>Le geste est rapide (&lt; 2 min) et n&rsquo;entra\u00eene pas de morbidit\u00e9 suppl\u00e9mentaire.<\/li><\/ul><p><strong>Conditionnement \u2014 2 pr\u00e9l\u00e8vements obligatoires :<\/strong><\/p><ul><li>Pr\u00e9l\u00e8vement 1 (formol) : fixation obligatoire au formol tamponn\u00e9 \u00e0 10 % pour microscopie optique (coloration au rouge Congo) et immunohistochimie.<\/li><li>Pr\u00e9l\u00e8vement 2 (tissu frais) : non fix\u00e9, sur compresse humide + s\u00e9rum physiologique NaCl 0,9 %, cong\u00e9lation rapide \u00e0 -80\u00b0C ou envoi rapide au laboratoire, pour immunofluorescence et, si besoin, spectrom\u00e9trie de masse (LCM-MS).<\/li><\/ul><p><strong>Ce qu&rsquo;il faut demander sur le bon d&rsquo;anatomopathologie :<\/strong><\/p><p><em>Libell\u00e9 recommand\u00e9 : \u00ab Recherche et typage de d\u00e9p\u00f4ts amylo\u00efdes (AL vs TTR). Rouge Congo + immunohistochimie anti-TTR, anti-\u03ba, anti-\u03bb \u2014 tissu frais disponible pour immunofluorescence \u00bb.<\/em><\/p><ul><li>Coloration au rouge Congo avec examen en lumi\u00e8re polaris\u00e9e (bir\u00e9fringence vert pomme = d\u00e9p\u00f4ts amylo\u00efdes).<\/li><li>Immunohistochimie (IHC) : anti-TTR, anti-kappa (\u03ba), anti-lambda (\u03bb) \u2014 pour typer AL vs TTR.<\/li><li>Si tissu frais disponible : immunofluorescence directe (anti-TTR, anti-\u03ba, anti-\u03bb).<\/li><li>Si discordance ou doute : spectrom\u00e9trie de masse coupl\u00e9e \u00e0 la microdissection laser (LCM-MS), technique de r\u00e9f\u00e9rence absolue pour le typage.<\/li><\/ul><p>Un r\u00e9sultat \u00ab amylose positive \u00bb sans typage ne suffit pas. L&rsquo;amylose AL est une urgence h\u00e9matologique (chimioth\u00e9rapie ou greffe de cellules souches \u00e0 envisager rapidement) ; l&rsquo;amylose TTR rel\u00e8ve d&rsquo;un suivi cardiologique sp\u00e9cialis\u00e9 et de th\u00e9rapeutiques cibl\u00e9es r\u00e9centes (tafamidis, patisiran, inotersen, eplontersen). Une confusion entre les deux types peut conduire \u00e0 une prise en charge inadapt\u00e9e et retarder un traitement salvateur.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-297cc06 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"297cc06\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e09b08a\" data-id=\"e09b08a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-413c8cb elementor-widget elementor-widget-heading\" data-id=\"413c8cb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Conduite \u00e0 tenir selon le r\u00e9sultat de la biopsie<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c6d9ba3 elementor-widget elementor-widget-text-editor\" data-id=\"c6d9ba3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<table width=\"623\"><tbody><tr><td width=\"180\"><p><strong>R\u00e9sultat<\/strong><\/p><\/td><td width=\"443\"><p><strong>Conduite \u00e0 tenir<\/strong><\/p><\/td><\/tr><tr><td width=\"180\"><p>Biopsie n\u00e9gative<\/p><\/td><td width=\"443\"><p>Absence de d\u00e9p\u00f4ts, pas d&rsquo;action sp\u00e9cifique, mais maintenir la vigilance si les facteurs de risque persistent ou s&rsquo;aggravent. Si tissu frais disponible : immunofluorescence directe (anti-TTR, anti-\u03ba, anti-\u03bb).<\/p><\/td><\/tr><tr><td width=\"180\"><p>Amylose ATTR confirm\u00e9e<\/p><\/td><td width=\"443\"><p>Adresser en cardiologie sp\u00e9cialis\u00e9e amylose. Bilan biologique pr\u00e9alable conseill\u00e9 avant la consultation : BNP ou NT-proBNP, troponine us, NFS, cr\u00e9atinine, bilan h\u00e9patique, prot\u00e9inurie.<\/p><\/td><\/tr><tr><td width=\"180\"><p>Amylose AL confirm\u00e9e ou suspect\u00e9e<\/p><\/td><td width=\"443\"><p>Avis h\u00e9matologique en urgence : \u00e9lectrophor\u00e8se des prot\u00e9ines s\u00e9riques + immunofixation, dosage des cha\u00eenes l\u00e9g\u00e8res libres s\u00e9riques (\u03ba\/\u03bb), my\u00e9logramme selon indication.<\/p><\/td><\/tr><\/tbody><\/table>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2f8673 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"d2f8673\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/documentation\/documentation-triptyques-reseau-amylose\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">T\u00e9l\u00e9chargez le triptyque \u00ab D\u00e9pister l'amylose cardiaque pour allonger la vie \u00bb \u2014 Ce que le chirurgien de la main doit savoir<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-67120e4 elementor-widget elementor-widget-text-editor\" data-id=\"67120e4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\" style=\"text-align: center\"><span style=\"color: #808080\"><em>Document r\u00e9dig\u00e9 par Dr Julien JEANNETEAU \u2013 Dr Nicolas BIGORRE \u2013 Pr Laurent OBERT \u2013 Pr Thibaud DAMY<\/em><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d675f63 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d675f63\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-3be745b\" data-id=\"3be745b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5d26ce1 elementor-widget elementor-widget-heading\" data-id=\"5d26ce1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Orientation vers les centres experts<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-119723f elementor-widget elementor-widget-text-editor\" data-id=\"119723f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"3569\" data-end=\"3741\">En pr\u00e9sence de signes rhumatologiques \u00e9vocateurs, il est <strong data-start=\"3626\" data-end=\"3707\">recommand\u00e9 de mettre vos patients en contact avec un centre expert en amylose<\/strong>.<br data-start=\"3708\" data-end=\"3711\" \/>Ces centres peuvent proposer :<\/p><ul><li data-start=\"3745\" data-end=\"3838\">Une <strong data-start=\"3749\" data-end=\"3782\">\u00e9valuation multidisciplinaire<\/strong> (cardiologie, h\u00e9matologie, neurologie, rhumatologie).<\/li><li data-start=\"3745\" data-end=\"3838\">La r\u00e9alisation des <strong data-start=\"3860\" data-end=\"3893\">examens diagnostiques adapt\u00e9s<\/strong> (imagerie cardiaque, analyses biologiques, scintigraphie, biopsie).<\/li><li data-start=\"3745\" data-end=\"3838\">Une <strong data-start=\"3970\" data-end=\"4011\">prise en charge th\u00e9rapeutique pr\u00e9coce<\/strong>, limitant la progression cardiaque et am\u00e9liorant la qualit\u00e9 de vie.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-553fa4c\" data-id=\"553fa4c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6df7337 elementor-widget elementor-widget-text-editor\" data-id=\"6df7337\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00a0<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ffb8d09 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"ffb8d09\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/reseau-amylose.org\/soins\/reseau-amylose-national\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Trouvez un centre expert \u00e0 proximit\u00e9<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d8c2bf3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d8c2bf3\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-56c7105\" data-id=\"56c7105\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-f7500e8\" data-id=\"f7500e8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2d6accc elementor-widget elementor-widget-image\" data-id=\"2d6accc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"768\" height=\"1005\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF-768x1005.png\" class=\"attachment-medium_large size-medium_large wp-image-7624\" alt=\"\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF-768x1005.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF-229x300.png 229w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF-782x1024.png 782w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF-1174x1536.png 1174w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF.png 1425w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-658d759\" data-id=\"658d759\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c9fbfd5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c9fbfd5\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6c0b205\" data-id=\"6c0b205\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3b63a22 elementor-widget elementor-widget-heading\" data-id=\"3b63a22\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">FAQ \u2014 Questions fr\u00e9quentes<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1b0edf0 elementor-widget elementor-widget-toggle\" data-id=\"1b0edf0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2831\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2831\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quand un chirurgien de la main doit-il envisager une biopsie amylo\u00efde ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2831\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2831\"><p>Devant un canal carpien (ou une autre atteinte \u00e9vocatrice) chez un patient de plus de 60 ans : syst\u00e9matique chez l&rsquo;homme d\u00e8s 1 facteur de risque, conseill\u00e9e puis syst\u00e9matique chez la femme \u00e0 partir de 2 facteurs, et syst\u00e9matique en cas de canal carpien bilat\u00e9ral isol\u00e9 apr\u00e8s 70 ans.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2832\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2832\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Le pr\u00e9l\u00e8vement biopsique allonge-t-il significativement l'intervention ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2832\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2832\"><p>Non, le geste est rapide (moins de 2 minutes) et n&rsquo;entra\u00eene pas de morbidit\u00e9 suppl\u00e9mentaire.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2833\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2833\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Quel tissu pr\u00e9lever en cas de chirurgie du canal carpien ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2833\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2833\"><p>La synoviale des fl\u00e9chisseurs, pr\u00e9f\u00e9rable au ligament carpien transverse seul, avec un meilleur rendement diagnostique.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2834\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2834\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Que faire en cas de signes EPOF chez un patient adress\u00e9 pour chirurgie ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2834\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2834\"><p>L&rsquo;adresser en cardiologie en priorit\u00e9, avant toute chirurgie : essoufflement, prise de poids rapide, \u0153d\u00e8mes ou malaises orthostatiques peuvent t\u00e9moigner d&rsquo;une amylose cardiaque d\u00e9j\u00e0 install\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-55ade2a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"55ade2a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-806172d\" data-id=\"806172d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bdf0335 elementor-widget elementor-widget-text-editor\" data-id=\"bdf0335\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Le chirurgien de la main et l&rsquo;orthop\u00e9diste sont en premi\u00e8re ligne pour d\u00e9pister pr\u00e9cocement l&rsquo;amylose cardiaque : le canal carpien bilat\u00e9ral pr\u00e9c\u00e8de l&rsquo;atteinte cardiaque de 5 \u00e0 9 ans dans l&rsquo;ATTRwt (pr\u00e9valence 40-60 %), et le canal lombaire \u00e9troit est retrouv\u00e9 chez 34 % des patients op\u00e9r\u00e9s de st\u00e9nose lombaire apr\u00e8s 75 ans. Devant ces atteintes chez un patient de plus de 60 ans avec facteur de risque associ\u00e9, un pr\u00e9l\u00e8vement biopsique opportuniste peut \u00eatre r\u00e9alis\u00e9 pendant l&rsquo;intervention d\u00e9j\u00e0 pr\u00e9vue (canal carpien, arthroscopie, arthroplastie de hanche\/genou, d\u00e9compression lombaire), en moins de 2 minutes et sans morbidit\u00e9 suppl\u00e9mentaire. Le pr\u00e9l\u00e8vement doit toujours associer un \u00e9chantillon fix\u00e9 en formol et un \u00e9chantillon frais congel\u00e9 \u00e0 -80\u00b0C, apr\u00e8s contact pr\u00e9alable avec l&rsquo;\u00e9quipe d&rsquo;anatomopathologie. Le typage AL versus TTR est indispensable : l&rsquo;amylose AL est une urgence h\u00e9matologique, tandis que l&rsquo;amylose TTR rel\u00e8ve d&rsquo;un suivi cardiologique sp\u00e9cialis\u00e9 et de traitements cibl\u00e9s (tafamidis, patisiran). En cas de signes d&rsquo;insuffisance cardiaque (EPOF), le patient doit \u00eatre adress\u00e9 en cardiologie avant toute chirurgie.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-eab11b5 elementor-widget elementor-widget-text-editor\" data-id=\"eab11b5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>R\u00e9dig\u00e9 par<\/strong> : Contenu r\u00e9dig\u00e9 par l&rsquo;\u00e9quipe du Centre de r\u00e9f\u00e9rence des Amyloses Cardiaques<\/li><li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>Relu \/ valid\u00e9 par<\/strong> : Pr Thibaud DAMY, cardiologue, Coordonateur du CRAC Centre de R\u00e9f\u00e9rence des Amyloses Cardiaques APHP &#8211; CHU Henri-Mondor<\/li><li class=\"font-claude-response-body whitespace-normal break-words pl-2\"><strong>Date de derni\u00e8re mise \u00e0 jour<\/strong> 08\/2026<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>R&rsquo;EPOF &#8211; Les atteintes rhumatologiques dans le diagnostic pr\u00e9coce de l&rsquo;amylose TIC-TAC, changeons de TAC-TIC et passons du TACoTAC En tant que chirurgien de la main ou orthop\u00e9diste, vous op\u00e9rez d\u00e9j\u00e0 les patients porteurs des atteintes les plus \u00e9vocatrices d&rsquo;amylose cardiaque : canal carpien, canal lombaire, arthroplastie de hanche ou de genou. Un pr\u00e9l\u00e8vement biopsique [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-7634","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Amylose cardiaque \u2014 Ce que le chirurgien de la main doit savoir - R\u00e9seau Amylose<\/title>\n<meta name=\"description\" content=\"Sensibiliser les chirurgiens de la main et orthop\u00e9distes aux signes rhumatologiques pouvant r\u00e9v\u00e9ler une amylose cardiaque\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/professionnels-chirurgien-main-orthopediste\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Amylose cardiaque \u2014 Ce que le chirurgien de la main doit savoir - R\u00e9seau Amylose\" \/>\n<meta property=\"og:description\" content=\"Sensibiliser les chirurgiens de la main et orthop\u00e9distes aux signes rhumatologiques pouvant r\u00e9v\u00e9ler une amylose cardiaque\" \/>\n<meta property=\"og:url\" content=\"https:\/\/reseau-amylose.org\/jesuissoignant\/professionnels-chirurgien-main-orthopediste\/\" \/>\n<meta property=\"og:site_name\" content=\"R\u00e9seau Amylose\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-25T18:40:15+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/01\/REPOF-768x1005.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/professionnels-chirurgien-main-orthopediste\/\",\"url\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/professionnels-chirurgien-main-orthopediste\/\",\"name\":\"Amylose cardiaque \u2014 Ce que le chirurgien de la main doit savoir - 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