Department of rheumatology, hôpital Lariboisière, 75010 Paris, France; University Paris 7, 75013 Paris, France.
Department of bone and joint imaging, hôpital Lariboisière and university, 75010 Paris, France.
Joint Bone Spine. 2019 Mar;86(2):233-238. doi: 10.1016/j.jbspin.2018.08.005. Epub 2018 Sep 19.
Beta-2-microglobulin (β2M) dialysis-related amyloidosis (DRA), a disabiliting joint disease, has been initially reported in patients under long-term dialysis. The incidence and prevalence has significantly decreased with the improvement in dialysis techniques. Here, we attempted to clarify the clinical and MRI features to improve the diagnosis.
We retrospectively reviewed the files of 19 patients under dialysis treatment referred for suspicion of β2M DRA. The diagnosis was based on MRI criteria (low signal intensity on both T1- and T2-weighted MR sequences). MRI analysis included a scoring of the several joint lesions. Scores were quantified according to a severity scale (0 to 3).
Patients had a mean age of 66.0 ± 10.5 years and mean dialysis duration of 23.7 ± 10.5 years. DRA affected mainly large joints (shoulder in 73.7%, hip in 47.3%) and spine (36.8%). MRI images for 8 shoulders, 8 hips, and 3 spines were analysed. Amyloid synovitis was present in all cases, with high mean scores in the three sites. In all joints, the most common lesions were tendon thickening (68.4%) and bone erosions (68.4%). The mean tendon thickening score was high, particularly at the shoulders and also at the spine. Bone erosions were most frequent in the shoulder and pelvis.
In patients under long-term dialysis, β2M DRA involves large joints but also the spine. Special awareness should be drawn by the thickening of the tendon. MRI is required to characterize the pattern of the lesions and to achieve the diagnosis.
β2-微球蛋白（β2M）透析相关性淀粉样变（DRA）是一种致残性关节疾病，最初见于长期透析患者。随着透析技术的改进，其发病率和患病率显著下降。在此，我们试图阐明其临床和 MRI 特征，以提高诊断率。
我们回顾性分析了 19 例透析治疗患者的病历，这些患者因疑似β2M DRA 而接受检查。诊断基于 MRI 标准（T1 和 T2 加权 MR 序列上均呈低信号强度）。MRI 分析包括对几种关节病变的评分。根据严重程度量表（0-3 分）对评分进行量化。
患者平均年龄为 66.0±10.5 岁，透析时间平均为 23.7±10.5 年。DRA 主要影响大关节（73.7%为肩部，47.3%为髋关节）和脊柱（36.8%）。分析了 8 个肩部、8 个髋关节和 3 个脊柱的 MRI 图像。所有病例均存在淀粉样滑膜炎，三个部位的平均评分均较高。在所有关节中，最常见的病变是肌腱增厚（68.4%）和骨侵蚀（68.4%）。所有关节的肌腱增厚评分均较高，尤其是肩部和脊柱。骨侵蚀最常见于肩部和骨盆。
在长期透析患者中，β2M DRA 不仅累及大关节，还累及脊柱。应特别注意肌腱增厚。MRI 是明确病变模式和诊断的必需手段。
