Long-term regular haemodialysis for chronic renal failure is associated with amyloidosis. In this condition excess amounts of the unexcretable plasma protein beta-microglobulin are laid down in tendons, joints and bones. Amyloidosis presents with various musculoskeletal disorders only after several years of dialysis. We reviewed 83 patients who had been dialysed for at least 10 years. The commonest complaint was severe joint pain in the absence of radiological changes of arthritis (41%), the shoulders usually being the most affected (33%). Carpal tunnel syndrome had developed in 26 patients, and was bilateral in 14 of them; at operation the presence of amyloid was confirmed. Six of these patients had recurrent symptoms after a further two to three years and required another decompression. Other manifestations of amyloidosis included trigger finger, flexor tendon contracture, spontaneous tendon rupture and pathological fracture through amyloid bone cysts. The frequency of symptoms was proportional to the duration of dialysis: all 13 patients on dialysis for over 20 years were affected. Symptoms developed earlier in older patients.

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The pathophysiology of heterotopic periarticular ossification is not understood.Though local agents may be responsible, factors present in the serum may be contributory. Sera from 4 paraplegic patients with heterotopic ossification and 4 'normal' paraplegics were incubated with human osteoblasts in tissue culture and their metabolic acitivy was measured quantitatively. There were significantly greater levels of osteoblast stimulating factors present in the sera of ossifying patients, (p < 0.01). These factors may contribute to the pathogenesis of heterotopic ossification.

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