Musculoskeletal manifestations of amyloidosis : a review of 83 patients on haemodialysis for at least 10 years

• Published in: Journal of bone and joint surgery. British volume Vol. 73; no. 2; pp. 271 - 276
• Main Authors: KURER, M. H. J, BAILLOD, R. A, MADGIWCK, J. C. A
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.03.1991
• Subjects: Adolescent; Adult; Aged; Amyloidosis - diagnostic imaging; Amyloidosis - etiology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone Diseases - diagnostic imaging; Bone Diseases - etiology; Child; Child, Preschool; Emergency and intensive care: renal failure. Dialysis management; Humans; Intensive care medicine; Joint Diseases - diagnostic imaging; Joint Diseases - etiology; Kidney Failure, Chronic - therapy; Medical sciences; Middle Aged; Muscular Diseases - etiology; Radiography; Renal Dialysis - adverse effects; Time Factors; Human; Nervous system diseases; Urinary system disease; Amylase; Hemodialysis; Diseases of the osteoarticular system; Joint; Striated muscle; Long term; Extrarenal dialysis; Treatment; Complication; Bone; Technique; Resuscitation
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620x.73b2.2005153

Long-term regular haemodialysis for chronic renal failure is associated with amyloidosis. In this condition excess amounts of the unexcretable plasma protein beta-microglobulin are laid down in tendons, joints and bones. Amyloidosis presents with various musculoskeletal disorders only after several years of dialysis. We reviewed 83 patients who had been dialysed for at least 10 years. The commonest complaint was severe joint pain in the absence of radiological changes of arthritis (41%), the shoulders usually being the most affected (33%). Carpal tunnel syndrome had developed in 26 patients, and was bilateral in 14 of them; at operation the presence of amyloid was confirmed. Six of these patients had recurrent symptoms after a further two to three years and required another decompression. Other manifestations of amyloidosis included trigger finger, flexor tendon contracture, spontaneous tendon rupture and pathological fracture through amyloid bone cysts. The frequency of symptoms was proportional to the duration of dialysis: all 13 patients on dialysis for over 20 years were affected. Symptoms developed earlier in older patients.