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Amyloidosis containing β2 microglobulin (β2m) and joint pains are frequent complications of long-term hemodialysis. In a prospective study the authors planned to act on dialysis arthropathies (DA) by improving β2m depuration: for 8 patients suffering from DA we replaced usual cuprophane membranes (CU) by high permeability polyacrylonitrile membranes (PAN). DA was diagnosed on the presence of severe disabling arthralgias in the absence of any other obvious etiology, and on the presence of at least 3 among 6 criteria. The efficacy of the switch of DM was assessed on 6 criteria including the patient's own evaluation at the end of the study and a joint pain severity index. Clinical evaluation and β2m measurement were carried out at the start of the trial and after a mean duration of dialysis on PAN of 6 months. An improvement in joint symptomatology and a decrease of joint severity index were noted in the 8 cases. Our results suggest that the change of DM has a favorable influence on DA. This improvement could result either from a better β2m depuration or from a better biocompatibility of PAN than the CU previously used. [ABSTRACT FROM AUTHOR]

Objective: The incidence of destructive spondyloarthropathies (SpA) in hemodialysis can reach 50% after 10 years of treatment. Few studies have analyzed the magnetic resonance (MR) appearance of destructive SpA and data are controversial. Our objective was to evaluate the computerized tomographic (CT) scan and MR appearance of destructive SpA in comparison to infectious spondylodiscitis., Methods: 23 destructive SpA were observed in 11 patients who had undergone hemodialysis [mean duration of treatment 12 years (89-228 mo)]: 17 SpA of the cervical spine, one of the dorsal, and 5 of the lumbar spine. CT scans at all levels demonstrating narrowing and discovertebral erosions were performed without injection. MRI was performed with T1 and T2* weighted spin echo sequences (0.5T) without gadolinium injection. Radiographs were analyzed by 2 independent examiners. The data concerning MRI of infectious spondylodiscitis were based on a study of 57 personal cases and literature reports., Results: CT scan appearance was similar in all cases, especially showing multiple small well defined lucencies of the vertebral endplates. In 9 patients, MRI showed low signal intensity of the disk and the adjacent vertebral endplates on T1 and T2* sequences. In no case was discal or vertebral high signal intensity on T2* sequence noted. No periodontoidal pseudotumor was observed., Conclusion: CT scans and MRI of destructive SpA, even nonspecific, are different from those observed in infectious spondylodiscitis, particularly due to the absence of discal and vertebral hypersignal on T2* sequences.

Unlabelled: To assess the iodine-123-labelled serum amyloid P component (SAP) scintigraphy in patients with haemodialysis-associated amyloidosis., Patients: Eight patients with histologically proven beta 2-microglobulin amyloidosis., Methods: Purified SAP was iodinated by a modified iodogen method. Whole body data were acquired with a large rectangular field gamma-camera., Results: In 7 cases, articular uptake was observed in the symptomatic joints (shoulders, wrists, knees) or in view of bone cysts (wrists). Among the 3 patients with erosive arthropathy of the hands, only one had positive scintigraphy. None positive scintigraphic image was obtained in the spine or the hip joint. In one patient with multifocal amyloid joint disease, no positive image was noted. No abnormal visceral uptake was observed and particularly of the spleen except in one patient with liver uptake., Conclusion: I-123 SAP scintigraphy might be not very sensitive in diagnosing beta 2 amyloid deposits. This method needs further investigations and particularly in patients undergoing haemodialysis for more than 20 years.

Clinical and radiological analysis of a population of 80 patients undergoing hemodialysis showed a high incidence of joint symptoms and radiological abnormalities which could not with certainty be attributed to renal osteodystrophy (Part 1). In this same population, laboratory and pathologic studies were performed. Blood chemistry proved abnormal in most cases (fibrinogen, aluminum, beta 2 microglobulin). Histopathologic studies (bone or synovial) were performed in 20 samples. Amyloid deposits were found in 8 samples, and crystal deposits in 3. We consider the idea that amyloid may be responsible for the observed lesions to be an interesting possibility. A better understanding of the behavior of different dialysis membranes may clarify the pathophysiological mechanisms of this disease.

In a group of 80 patients dialyzed at the same dialysis center, dialysis arthropathy was diagnosed in ten of them. Before commencing the study all ten patients were undergoing hemodialysis with cuprophan membrane (CU). We then replaced CU with high permeability membrane (polyacrylonitrile AN 69 Hospal or polysulfone) in eight of these ten patients. Clinical and radiological evaluation as well as bêta 2 microglobulin measurement were performed at the onset of the study and at one year and two years intervals after replacing the dialysis membrane. An improvement of joint symptomatology was noted in all patients. However, the radiological abnormalities appeared unchanged or aggravated and the mean serum concentration of bêta 2 microglobulin was lower at the end of the study but not significantly.

Eighty patients studied for several years (average length of time: 76 months, 24 on hemodialysis for over 10 years), were the subject of a prospective study of osteoarticular manifestations. Clinically, these manifestations were found in 58 patients (72 p. cent). Among them, 15 suffered from inflammatory painful episodes (shoulders and fingers) and 10 presented a decreased finger mobility. Radiologically, it is possible to describe 7 types of specific images: erosive arthropathy of the fingers (8 p. cent), multiple carpal cavities (10 p. cent), cavity of the humeral head (9 p. cent), cervical spondylolisthesis (5 p. cent), multiple diaphyseal lacunae (1 p. cent). Some clinical and radiological manifestations are frequently associated and seem to represent a specific pathological group: dialysis in progress for more than ten years, carpal tunnel syndrome, inflammatory-type arthralgias, osseous cavities and spondylo-arthropathy. Biologically, there are numerous disturbances concerning the sedimentation rate, fibrinemia, aluminum blood level, phosphorus blood level, parathyroid hormone and beta-2-microglobulin blood level. The study of bone or synovium biopsies, carried out 20 times, permitted to discover amyloid deposits in 8 instances and microcrystals in 3 instances. The physio-pathogeny of these manifestations leads to evoke the role of many factors (aluminum, microcrystals, silicon, hyperparathyroidism, amylosis). The occurrence of a form of amylosis where a protein homologous to beta-2-microglobulin was isolated, appears to be feasibly the consequence of a bio-incompatibility of the dialysis membranes.

In a prospective study, 80 patients undergoing long-term hemodialysis, 30% more than ten years, were evaluated for joint function and radiographic abnormalities; 58 patients (72%) had clinical symptoms; non-specific arthralgia was the most frequent; 15 patients had inflammatory pain (shoulders 9, hands 3) and diminution of finger mobility (10). Radiological examinations showed 40 abnormal findings in 23 patients (28%): erosive arthropathies of fingers (4), and multiple geodes of the carpus (8), of the humeral head (7) or of the hip (9). We also detected spondylolisthesis (4), erosive arthropathy of cervical (6) or lumbar (2) spine. Pathological study of synovial biopsies was performed in 16 cases. Amyloidosis was found in 4 samples taken routinely. In 2 other cases the biopsy was done on the basis of lesions seen on x-rays: we found amyloidosis in the synovial membrane in both patients and in the bone in one. In 8 patients we found C3 deposits positive in immunofluorescence. These results underline the role of amyloidosis in the mechanism of some arthropathies in long-term hemodialysis patients.

Eighty patients undergoing longterm hemodialysis were evaluated for joint function and radiographic abnormalities. Mean age of the population was 53 years, and mean duration of dialysis was 76 months (24 patients underwent dialysis for more than 10 years). Fifty-eight patients (72%) had joint symptoms; nonspecific arthralgia was the most frequent. Fifteen patients had morning stiffness and interrupted sleep due to arthralgias (shoulders 9, fingers 3) and 10 patients had diminished finger mobility. Radiographic evaluation showed 7 classes of lesions which are not characteristic of renal osteodystrophy or degenerative lesions, including erosive arthropathies of the fingers (8%), multiple carpal bone cysts (10%), cysts of the humeral head (9%), cysts of the hip (11%), erosive spondyloarthropathies (9%), cervical spondylolisthesis (5%) and multiple diaphyseal lacunae (1%). Overall, 42 distinct radiological lesions were observed in a total population of 23 patients. Twenty-nine of these lesions occurred in patients undergoing dialysis for at least 10 years. Certain clinical and radiological patterns were frequently combined after dialysis for more than 10 years: carpal tunnel syndrome, inflammatory joint pain, bone cysts and spondyloarthropathies.