Synovial amyloid in chronic haemodialysis contains beta 2 microglobulin.

Abstract

SUMMARY A case of amyloid arthropathy occurring in a patient receiving long term chronic haemodialysis treatment is reported. He was found to have raised serum 132 microglobulin (132M), and 132M was detected in the synovial amyloid deposits.One of the complications of long term chronic haemodialysis is amyloid arthropathy. 1-3 We describe a patient, in whom 12 microglobulin (132M) was found in the synovial amyloid deposits. Case reportThe patient was a 38 year old man who was in chronic renal failure from chronic glomerulonephritis of unknown cause. He had received regular haemodialysis treatment for 18 years using a cuprophane haemodialysis membrane. He had had four unsuccessful renal transplants during that time. A total parathyroidectomy was performed in 1982. He had a left total hip replacement in 1980 and a right total hip replacement in 1981. Both carpal tunnels were decompressed in 1985 for carpal tunnel syndrome, but no histology was performed. Over the last 18 months he gradually developed pain, swelling, and stiffness of the shoulders, wrists, left thumb, knees, and left ankle.Clinically there was swelling, pain, and restriction of all these joints with effusions in the knees and shoulders. There were no rheumatoid nodules or gouty tophi. The erythrocyte sedimentation rate was 10 mm/h, and tests for rheumatoid factor and antinuclear antibodies were negative. Serum uric acid, calcium, and phosphate were normal. Serum 132 microglobulin on two occasions was 44 and 46 mg/l (Pharmacia RIA -normal up to 3 mg/l).

Dialysis‐Related Amyloidosis: History and Clinical Manifestations

“…The joint effusions are usually paucicellular (43), and cell count ranges from 80 to 1100 white blood cells/ml (44). β 2 M amyloid can be demonstrated in the synovium or the synovial fluid by Congo red and immunostaining (45, 46). Radiologic examination of the affected joints may show erosion of surfaces of the joint capsule and articular narrowing.…”