Abstract
Recently, it has been increasingly recognized that long-term hemodialysis (HD) patients have complicating amyloid osteoarthropathy and that cystic radiolucency is observed in the affected joints. In order to clarify the relationship between the cystic bone lesions and amyloid osteoarthropathy in HD patients, we studied the cystic radioluceny of the wrist joints and their correlation with clinical and laboratory parameters in 376 HD patients. The cystic radiolucency was classified into four grades: (-), (±), (+) and (++). Cystic lesions were noticed in 86 patients (22.9%), in which there was no sex-related difference in the incidence of positive cystic lesions. The incidence was 33.0% among 103 patients who had received long-term HD for more than 10 years compared with 19.0% among 273 patients on HD for less than 10 years. Cystic lesions were also seen in 68.4% among 19 patients with carpal tunnel syndrome (CTS) compared with 20.4% among 357 patients without CTS. Patients with higher cystic grades were older, and had been receiving hemodialysis for longer periods. There was no relationship between the grades of cystic lesions and serum levels of PTH-C, aluminum or β2-microglobulin. Biopsy specimens of bone cysts in two patients demonstrated amyloid deposits, which showed an immunohistochemically positive reaction with rabbit antihuman β2-microglobulin antibody. It is suggested that cystic raiolucency in the wrist joints of HD patients is indicative of amyloid deposition and that it could be a useful marker for the diagnosis of amyloid osteoarthropathy.
