[Current aspects of osteoarticular pathology of hemodialyzed patients. Study of a population of 80 patients].

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.