Villiaumey J, Larget-Piet B, Pointud P
Rev Rhum Mal Osteoartic. 1975 Jan;42(1):25-34.
The authors confirm the great rarity of joint complications in patients with Kahler's disease. Among the records of 1953 cases the following complications were the only one found: 2 cases of proved articular amylosis, 2 cases of probable articular amylosis, 3 cases of possible articular amylosis, 20 cases of arthropathy that were impossible to classify, 27 cases of compression of the median nerve in the carpan canal, 6 cases of gouty arthritis, and 3 cases of septic arthritis. The data on symptoms obtained in the course of this enquiry are in conformity with the data in the literature. Articular amylosis often takes on the appearance of a polyarthritic syndrome of progressive installation and extension, involving in particular the hands and the wrists, but sometimes involving in a symmetrical bilateral manner the elbows, the shoulders, and the knees. The affected joints are swollen, stiff, and painful. Local signs of inflammation are, however, often absent. The deformations characteristic of rheumatoid arthritis do not develop. The joints do not show radiological signs for most of the time. In addition, it is not possible to detect the rheumatoid factor in the serum. The arthropathies can also assume an oligo-articular topography. Articular discharges are very frequent: they are usually of a mechanical nature. Whatever the clinical appearance, an exact diagnosis can be established only by means of anatomo-pathological examination of the synovial membrane or of certain para-articular amyloid nodules. Myelomas complicated by amyloid articular deposits are often light chain, with only little increase in the erythrocyte sedimentation rate, discrete hyperproteinaemia, moderate medullary plasmocytosis, and rare or limited radiological lesions. The carpal canal syndrome is either isolated or included within the framework of a polyarthropathy. Compression of the median nerve is due to amyloid infiltration into the synovial sheath of the tendons of the finger flexors, proof of which is not always easy. Gout is rare despite the frequency of hyperuricacidaemia caused by renal insufficiency. Septic arthritis is often caused by renal insufficiency. Septic arthritis is often caused by pneumococci to which those with a myeloma appear particularly suceptible.
作者证实卡勒氏病患者关节并发症极为罕见。在1953例病例记录中，仅发现以下并发症：2例确诊关节淀粉样变，2例可能关节淀粉样变，3例可能关节淀粉样变，20例无法分类的关节病，27例腕管综合征正中神经受压，6例痛风性关节炎，3例化脓性关节炎。本次调查过程中获得的症状数据与文献中的数据一致。关节淀粉样变常表现为进行性起病和扩展的多关节炎综合征，尤其累及手和腕部，但有时也会对称累及双侧肘部、肩部和膝部。受累关节肿胀、僵硬且疼痛。然而，炎症的局部体征通常不存在。类风湿关节炎特有的畸形不会出现。大多数情况下，关节在放射学上无异常表现。此外，血清中无法检测到类风湿因子。关节病也可能呈现少关节分布。关节积液非常常见：通常是机械性的。无论临床表现如何，只有通过对滑膜或某些关节旁淀粉样结节进行解剖病理学检查才能做出准确诊断。合并淀粉样关节沉积的骨髓瘤通常为轻链型，红细胞沉降率仅略有升高，有轻度高蛋白血症，中度骨髓浆细胞增多，放射学病变少见或局限。腕管综合征可单独出现，也可包含在多关节病的范畴内。正中神经受压是由于淀粉样物质浸润到指屈肌腱的滑膜鞘，但其证据并不总是容易获得。尽管肾功能不全导致高尿酸血症很常见，但痛风却很少见。化脓性关节炎常由肾功能不全引起。化脓性关节炎常由肺炎球菌引起，骨髓瘤患者似乎对此特别易感。
