[Rheumatologic complications and amyloidosis in dialysis patients]

Articular complications seem to be very common in patients under chronic dialysis, where they currently constitute the main limitation to the long-term functional prognosis. Carpal tunnel syndrome is often bilateral and severe; after 8 to 10 years of haemodialysis, it is usually associated with local deposits of amyloid substance. Treatment must be undertaken early and it is surgical. Arthropathies due to microcrystalline deposits take various forms, the most frequent being acute periarticular attacks related to apatite crystals. Septic arthritis is a frequent complication, dangerous in such patients, and which must be considered in every case of acute or subacute arthritis. Chronic arthropathies affect more than one half of the patients who have been under dialysis for more than 10 years. The most common are arthralgias of the shoulders often associated with pain in other joints, restricted joint movements and synovial thickening notably in the wrists, small finger joints and knees; radiology shows subchondral cavities betraying the presence of the cervical spine, are fairly frequent in patients under long-term haemodialysis. The pathogenesis of these complications is not yet fully understood, and several factors may be involved. Anatomically, carpal tunnel syndrome and chronic arthropathies are associated with articular deposits of a very special amylose consisting of beta-2 microglobulins.