Background: Inflammatory (AA) amyloidosis is secondary to chronic inflammatory conditions. The discovery of an AA amyloidosis can reveal the underlying inflammatory disease, but the etiologic diagnosis can be challenging. Considering this diversity of etiologies, we proposed the “AA Challenge”: an international educational program aimed mainly at French-speaking physicians, thanks to financial support: Françoise Dubois Charlier Prize from the French Association of Amyloidosis Patients (AFCA).

Objectives: The aim of the AA challenge was to teach and communicate the diversity of causes of AA amyloidosis in order to reduce diagnostic wandering. It also intended to encourage interaction and scientific emulation on AA amyloidosis between French-speaking physicians caring for AA amyloidosis patients around the world.

Methods: From 2023 to 2024, a monthly clinical case consisting of images with a short text was proposed to the French-speaking medical community under the name “AA challenge” via emails and social networks accounts of the French reference center for AA amyloidosis, the French association against amyloidosis, the international alliance against amyloidosis, a Facebook page and Instagram account “AA challenge”. The questionnaire was developed using Eval&Go® software and distributed thanks to the twelve members of the AA challenge Steering Committee, each representing their French-speaking country. After the monthly challenge case (quiz), a 40-second educational video explaining the correct answer and the various elements that guide the diagnostic strategy is posted on social networks. We have also provided a monthly “literature review” on AA amyloidosis, consisting of a summary of two recent articles on AA amyloidosis, which was shared on social media.

Results: A total of 12 clinical cases of AA amyloidosis were sent allowing to collect 2567 responses over one year. The medical specialties of the AA Challenge participants were respectively: internal medicine (n=1534, 60%), nephrology (n=470, 18%), rheumatology (n=199, 7%) and other specialties (cardiology, dermatology, gastroenterology, geriatrics pediatrics and infectious diseases (n=307,11%). The top three participating countries with the highest number of voters in the 12 quizzes were Morocco (n=646), France (n=537) and Romania (n=420). The number of voters from the remaining countries were: Tunisia (n=273), Algeria(n=212), Belgium (n=147), Senegal (n=156), Lebanon (n=72), Switzerland (n=56) and Canada (n=48). The pathologies studied in the different clinical cases and the percentage of correct answers were respectively in order of publication: 1-Mevalonate Kinase deficiency (57%), 2-Tuberculosis and bronchectasis (41%), 3-Familial Mediterranean Fever (73%), 4-Rheumatoid arthritis (80%), 5-Obesity (62%), 6-Primary hyperoxaluria (58%), 7-Castelman disease (60%), 8-Spondylarthritis (80%), 9- Multiple causes (70%), 10-Cryopyrinopathy (58%), 11-Crohn disease (88%), 12- non AA amyloidosis (29%). For the monthly literature review, 25 articles on AA amyloidosis published between 2022 and 2024 during the project period were summarized. Topics covered were, in order of frequency, 10 rare causes of AA amyloidosis (including variable common immune deficiency, hidradenitis suppurativa, inflammatory lymphomas, xanthogranulomatous pyelonephritis, sickle cell disease, PSTPiP1 mutations, anakinra, checkpoint inhibitors such as atezolizumab, Behçet’s disease and hereditary epidermolysis bullosa), 6 on the epidemiology of AA amyloidosis in some countries (such as Brazil, Portugal, Algeria and Turkey), familial Mediterranean fever, anti-inflammatory cytokine biotherapies and disease progression or kidney transplantation; Only one involved inflammatory rheumatism (gout), a classic but declining aetiology of AA amyloidosis.

Conclusion: The “AA challenge” educational project brought together >10 French-speaking countries to discuss the various causes of AA amyloidosis. This project attracted more than 2500 colleagues from at least 8 different specialties. The high number of responses to the questionnaire indicates an interest in the subject and in fun approaches to teaching. Overall, the AA challenge encourages us to continue this educational work to raise awareness on AA amyloidosis.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.