Nishi Shinichi, Hoshino Junichi, Yamamoto Suguru, Goto Shunsuke, Fujii Hideki, Ubara Yoshifumi, Motomiya Yoshihiro, Morita Hiroyuki, Takaichi Kenmei, Yamagata Kunihiro, Shigematsu Takashi, Ueda Mitsuharu, Ando Yukio
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Nephrology, Toranomon Hospital Kajigaya, Tokyo, Japan.
Nephrology (Carlton). 2018 Jul;23(7):640-645. doi: 10.1111/nep.13077.
Dialysis-related amyloidosis (DRA) exhibits multiple bone-articular lesions, such as carpal tunnel syndrome (CTS), trigger finger (TF), spinal canal stenosis (SCS), destructive spondyloarthropathy (DSA), bone cysts, and joint pains. DRA leads to a decrease in activities of daily living (ADL). We investigated the initiation of CTS and TF, and evaluated the relationship between walking disturbances and bone-articular lesions or joint pains.
A multicentre cross-sectional study was performed. Eighty-two patients with clinical DRA from 20 hospitals in Japan were evaluated.
Of the 82 patients, the first symptom of DRA was CTS in 39 patients (47.6%) and TF in 21 (25.6%). The mean new-onset vintages of 21 earlier cases in the CTS and TF groups were 86.1 ± 36.3 and 133.2 ± 56.4 (mean ± SD) months, respectively (P = 0.0091). The development of SCS and DSA appeared to be later than CTS and TF. Multiple regression analysis revealed that knee joint pain was a significant contributor to walking disturbances.
Carpal tunnel syndrome appeared significantly earlier than TF since the initiation of dialysis. In the advanced phase, knee joint pain was a major cause of decreased ADL in patients with clinical DRA.
透析相关性淀粉样变性（DRA）表现出多种骨-关节病变，如腕管综合征（CTS）、扳机指（TF）、椎管狭窄（SCS）、破坏性脊柱关节病（DSA）、骨囊肿和关节疼痛。DRA导致日常生活活动能力（ADL）下降。我们研究了CTS和TF的起始情况，并评估了行走障碍与骨-关节病变或关节疼痛之间的关系。
进行了一项多中心横断面研究。对来自日本20家医院的82例临床DRA患者进行了评估。
在82例患者中，DRA的首发症状为CTS的有39例（47.6%），为TF的有21例（25.6%）。CTS组和TF组21例较早发病患者的平均发病时间分别为86.1±36.3和133.2±56.4（平均值±标准差）个月（P=0.0091）。SCS和DSA的发生似乎晚于CTS和TF。多元回归分析显示膝关节疼痛是行走障碍的一个重要因素。
自透析开始以来，腕管综合征的出现明显早于TF。在晚期，膝关节疼痛是临床DRA患者ADL下降的主要原因。
