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Amyloid, advanced glycation end products, and dialysis related arthropathy
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Introduction |
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Dialysis associated arthropathy (DRA) is a syndrome peculiar to
long term dialysis patients. It includes large and small joint symptoms, pathological fractures through bony cysts and an axial spondyloarthropathy, and is closely associated with carpal tunnel syndrome. It is characterised by deposition of 
2 microglobulin (2M) as an amyloid protein. This was first linked to the
osteoarticular syndrome 12 years ago.1 Several other forms
of bone and joint pathology also occur more frequently in dialysis
patients, including secondary hyperparathyroidism, osteoporosis, gout,
pseudogout, and aluminium induced bone disease.2
Prevalence of DRA is closely related to age and years of dialysis
treatment. Symptoms develop in some patients within four to five years
of treatment and are almost universally present in those who have been
treated by haemodialysis for 15 years.2-4 The number of
patients in this at risk group is steadily increasing; in Australia the
proportion of patients with over 10 years exposure to
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