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[Osteoarticular amyloidosis caused by dialysis]
C Orzincolo1, P L Bedani, P N Scutellari
1Servizio di Radiologia, Arcispedale S. Anna, Ferrara.
La Radiologia Medica
|July 1, 1988
Summary
Long-term hemodialysis patients, particularly those using cuprophan membranes, can develop amyloidosis, characterized by beta 2-microglobulin deposition in bones and joints. X-rays revealed skeletal abnormalities in 45% of patients, with common sites including the shoulder, hip, and wrist.
Area of Science:
- Nephrology
- Rheumatology
- Radiology
Background:
- Amyloid accumulation in bone and joints is a recognized complication in long-term hemodialysis patients.
- Cuprophan membrane use is associated with a higher risk of this condition.
- Beta 2-microglobulin is the primary amyloid protein deposited in affected tissues.
Purpose of the Study:
- To investigate the prevalence and radiographic features of amyloidosis in the skeletal system of long-term hemodialysis patients.
- To characterize the specific bone and joint abnormalities associated with amyloid deposition.
Main Methods:
- Skeletal X-ray examination of 46 long-term hemodialysis patients (≥5 years).
- Analysis of radiographic patterns, including axial and peripheral lesions.
- Assessment of joint involvement and associated pathologies like destructive spondyloarthropathy.
Main Results:
- 45% of patients exhibited bone and joint abnormalities due to amyloid deposition.
- Most frequently affected joints were the shoulder, hip, and wrist.
- Destructive spondyloarthropathy was observed in 15% of cases, commonly affecting the cervical spine (85% of these cases).
- Appendicular abnormalities included geodes, pathologic fractures, marginal erosions, and soft tissue swelling.
- Cervical spine involvement showed intervertebral space narrowing, marginal erosion, and vertebral sclerosis.
Conclusions:
- Long-term hemodialysis, especially with cuprophan membranes, poses a risk for amyloid osteoarthropathy (AOD).
- Radiographic evaluation is crucial for identifying skeletal manifestations of AOD.
- AOD presents with diverse lesions affecting both appendicular and axial skeletons, notably the cervical spine.