慢性血液透析症例におけるアミロイド骨関節症の検討

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  • Clinical evaluation of amyloid osteoarthropathy in long-term hemodialysis patients

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Amyloid osteoarthropathy was found in 5 (6.6%) of 76 hemodialysis patients who complained of polyarthralgia and gait disturbance. Amyloid osteoarthropathy was suspected in 34 patients (44.7%) who complained of arthralgia. Their arthralgia disappeared or was reduced by HDF or HD using a high-performance membrane.<br>In the amyloid osteoarthropathies, polyarthralgia and cysts of the hand bones and other bones appeared in all cases, and carpal tunnel syndrome was present in 3 cases. The duration of hemodialysis in the amyloid osteoarthropathies was 127±36 months, longer than that in the patients with suspected amyloid osteoarthropathies and other hemodialysis patients.<br>In the amyloid osteoarthropathies, the serum level of, β2-MG was 48.7±6.4 mg/l, MG 37.7±9.5mg/l and BUN 97±11mg/l, higher than in the patients with suspected amyloid osteoarthropathies and the other hemodialysis patients. We conclude that one of the causes of high levels of β2-MG and MG is a high production rate induced by superoxidation. For the treatment of amyloid osteoarthropathy, HDF or HD using a high performance membrane was the most effective. Polyarthralgia disappeared or was reduced in 2 to 8 weeks. Steroid was effective.<br>We must use high-performance membranes in the early stage of hemodialysis treatment to prevent amyloid osteoarthropathy.

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