Amyloid, advanced glycation end products, and dialysis related arthropathy

• Published in: Annals of the rheumatic diseases Vol. 57; no. 4; pp. 193 - 195
• Main Authors: MCDONALD, S P, COATES, P T H, DISNEY, A P S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and European League Against Rheumatism 01.04.1998; BMJ Publishing Group LTD
• Subjects: Age; Amyloid - metabolism; beta 2-Microglobulin - metabolism; Bone diseases; Carpal tunnel syndrome; Cysts; Fractures; Glycation End Products, Advanced - metabolism; Humans; Investigations; Joint Diseases - etiology; Joint Diseases - metabolism; Joint Diseases - surgery; Kidney Transplantation; Leader; Membranes; Pain; Pathology; Peritoneal dialysis; Proteins; Renal Dialysis - adverse effects
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.57.4.193

Concentrations of serum amyloid P component are increased in patients with chronic renal failure and dialysis, but whether they contribute to increased amyloid deposition is unclear. 9 10 A major recent development has been the finding that the β2M amyloid fibrils are modified (by non-enzymatic combination of protein amino groups with sugar aldehyde groups) to form AGEs. 11 The AGEs are acidic isoforms and are more likely to form fibrils. 8 It is unclear whether AGEs are generated in the circulation or in situ, but generation is likely to be enhanced by the oxidative stress associated with chronic uraemia. 11 The existence of a receptor for AGE on monocytes and macrophages, and release of TNFα and IL1β stimulated by purified AGE modified β2M has been shown leading to the proposal of AGEs as the mediators of β2M related bone disease. 12 Clinical presentation In a detailed clinical survey at our institution of patients with more than 10 years dialysis treatment, 80% had pain or stiffness in large joints, 64% restriction of movement, 93% pain or stiffness in hands, 43% pain or stiffness in axial joints, and 43% clinical evidence of carpal tunnel syndrome. 2 These results are consistent with other reports. 3 4 13 14 All have shown that the prevalence of symptoms and radiographic changes is related to age and years of dialysis treatment. Trigger finger, flexor tendon contracture, haemarthrosis, and spontaneous tendon rupture may also occur. 3 Effusions are common in the larger joints; 14 of 26 long term dialysis patients in our hospital had glenohumeral joint effusions seen on magnetic resonance images (MRI).