Abstract
The clinical and pathological pictures of synovitis in 15 patients (8 male, 7 female) on long-term hemodialysis were studied. The average age of the patients was 54±7 years and the average period of hemodialysis was 12±3 years. They developed swelling, redness, and pain in the region of the bursa around the large joints: the hip (four patients), ankle (three), hand (three), elbow (three), and shoulder (one). The dialated bursae could be distinguished by CT and MRI findings. Eleven patients had carpal tunnel syndrome, for which a carpal tunnel release operation was done, four had bone cysts, and three had tumorous calcification. The infiltration of inflammatory cells, fibrous thickening, and β2-MG amyloid fibrils were recognized in the synovial tissues. In some cases with bone cysts, both adhesions of the synovial capsule with periosteum and bone necrosis were recognized. Fluid taken from the bursae was yellow, rather than turbid synovial fluid, and showed calcium crystals in some cases. Ultrastructurally, amyloid fibrils and free synovial cells were recognized in the synovial fluid. Culture of the fluid was negative. Based on the presence of β2-MG amyloid in synovial tissues of the bursa, this bursitis in dialysis patients is considered to be a dialysis-associated amyloidosis. The results of this report suggest that dialysis bursitis is related to bone cysts and tumorous calcification. We must, therefore, include bursitis as a possible diagnosis in patients complaining of arthralgia duruing long-term hemodialysis.
