Contribution à la physiopathologie de l'arthropathie des dialysés : aluminium et amylose Béta2-microglobulinique

Abstract : Dialysis-associated arthropathy (DAA) is recognised as a complication of long-term dialysis. Its diagnosis is based on clinical (carpal tunnel syndrome (CrS), arthralgia) and radiological criteria (cystic bone radiolucencies, destructive arthropathy and spondylarthropathy). [beta]2-microglobulin ([beta 2-M) amyloidosis has been shown to be of pathophysiological relevance. In our study, only CTS.containing [beta]2-M amyloid deposits confirmed by microscopie examination, were associated with other signs of DAA. Macroscopic compression of the median nerve by amyloid deposits or an associated flexor tenosynovitis was inconstant, But an inflammatory synovial reaction surrounding amyloid deposits was weIl demonstrated by MR imaging of the carpal tunnel. Other factors may play a role in DAA, alone or in association with amyloidosis. Aluminum accumulates in osteoarticular structures of dialysis patients. We have demonstrated thàt soluble aluminum compounds induced a severe synovitis with haemorrhagic effusion in the rabbit knee. As shown by our results in the rat subcutaneous air-pouch model, this toxicity may be due to an increased secretion of eicosanoids by parietal cells. Aluminosilicates and other aluminum complexes may protect against aluminum articular toxicity. Our results also suggest that circulating hyaluronan may reflect synovial proliferation in dialysis patients suffering from DAA.
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Isabelle Chary-Valckenaere. Contribution à la physiopathologie de l'arthropathie des dialysés : aluminium et amylose Béta2-microglobulinique. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2001. Français. ⟨NNT : 2001NAN11304⟩. ⟨tel-01748636⟩

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