Amyloid arthropathy
Updates to Article Attributes
Amyloid arthropathy is the extracellular depositionof the fibrous protein amyloid within the skeletal system. It is a skeletal manifestation of amyloidosis and may involve either the axial skeleton (especially the cervical spine) or the peripheralappendicular skeleton1.
Pathogenesis
Amyloid arthropathy results from deposition of β2-microglobulin, particularly in renal failure patients undergoing long-term haemodialysis.
Pathogenesis is probably multifactorial, and relates to the duration of renal failure, patient's age, age at commencing haemodialysis and duration of haemodialysis 2.
Amyloid protein is not filtered by standarddialysis membranes and tends to accumulate within the musculoskeletal system1.
Clinical presentation
Shoulder pain and carpal tunnel syndrome are themost common clinical manifestations. Symptoms are commonly bilateral.
Patients can also develop osteolytic bone lesions (amyloidomas).
Radiographic features
Plain film
Features of amyloid arthropathy are those of an erosive and destructive osteoarthropathy, involving most commonly the hips, shoulders and carpal bones. Distribution is frequently bilateral.
In the large joints,amyloid arthropathy resembles inflammatory arthritis with
- juxta-articularsoft-tissue swelling(s)
- mild periarticular osteoporosis, and
- subchondral cystic lesions, usually withwell-defined sclerotic margins
- joint space is usually normal in width untillate in the course of the disease
Patients with amyloidomas of bone or with largesubchondral lesions have a high prevalence of pathologic fractures.
MRI
The MR imaging appearance of amyloid infiltrationwithin or around the joint consists of extensive deposition of an abnormal softtissue that has
- T1 : low or intermediate signal intensity
- T2 : low to intermediate signal intensity
This abnormal material covers the synovialmembrane, fills subchondral defects, and extends to periarticular soft tissue. Joint effusion is usually present.
Differential diagnoses
Differential for multiple lytic bone lesions include:
- metastases
- multiple myeloma
However, the peri-articular distribution is a distinguishing feature.
-<p><strong>Amyloid arthropathy</strong> is the extracellular deposition-of the fibrous protein amyloid within the skeletal system. It is a skeletal manifestation of <a href="/articles/amyloidosis" title="Amyloidosis">amyloidosis</a> and may involve either the axial skeleton (especially the cervical spine) or the peripheral skeleton<sup>1</sup>.</p><h4>Pathogenesis </h4><p>Amyloid arthropathy results from deposition of β<sub>2</sub>-microglobulin, particularly in renal failure patients undergoing long-term haemodialysis.</p><p>Pathogenesis is probably multifactorial, and relates to the duration of renal failure, patient's age, age at commencing haemodialysis and duration of haemodialysis <sup>2</sup>.</p><p>Amyloid protein is not filtered by standard-dialysis membranes and tends to accumulate within the musculoskeletal system<sup>1</sup>.</p><h4>Clinical presentation</h4><p>Shoulder pain and carpal tunnel syndrome are the-most common clinical manifestations. Symptoms are commonly bilateral.</p><p><a name="Imaging_Findings_for_Amyloid_arthropathy"></a>Patients can also develop osteolytic bone lesions (amyloidomas).</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Features of amyloid arthropathy are those of an erosive and destructive osteoarthropathy, involving most commonly the hips, shoulders and carpal bones. Distribution is frequently bilateral.</p><p>In the large joints,-amyloid arthropathy resembles inflammatory arthritis with </p><ul><li>juxta-articular-soft-tissue swelling(s) </li><li>mild periarticular osteoporosis, and</li><li>subchondral cystic lesions, usually with-well-defined sclerotic margins</li><li>joint space is usually normal in width until-late in the course of the disease</li></ul><p>Patients with <a href="/articles/amyloidoma" title="amyloidoma">amyloidomas </a>of bone or with large-subchondral lesions have a high prevalence of <a href="/articles/pathologic-fracture" title="pathologic fracture">pathologic fractures</a>. </p><h5>MRI</h5><p>The MR imaging appearance of amyloid infiltration-within or around the joint consists of extensive deposition of an abnormal soft-tissue that has </p><ul><li><strong>T1 </strong>: low or intermediate signal intensity </li><li><strong>T2</strong> : low to intermediate signal intensity</li></ul><p>This abnormal material covers the synovial-membrane, fills subchondral defects, and extends to periarticular soft tissue. Joint effusion is usually present.</p><h4>Differential diagnoses</h4><p>Differential for multiple lytic bone lesions include:</p><ul><li>metastases</li><li><a href="/articles/multiple-myeloma" title="Multiple Myeloma">multiple myeloma</a></li></ul><p>However, the peri-articular distribution is a distinguishing feature.</p>- +<p><strong>Amyloid arthropathy</strong> is the extracellular deposition of the fibrous protein amyloid within the skeletal system. It is a skeletal manifestation of <a href="/articles/amyloidosis">amyloidosis</a> and may involve either the axial skeleton (especially the cervical spine) or the appendicular skeleton<sup>1</sup>.</p><h4>Pathogenesis </h4><p>Amyloid arthropathy results from deposition of β<sub>2</sub>-microglobulin, particularly in renal failure patients undergoing long-term haemodialysis.</p><p>Pathogenesis is probably multifactorial, and relates to the duration of renal failure, patient's age, age at commencing haemodialysis and duration of haemodialysis <sup>2</sup>.</p><p>Amyloid protein is not filtered by standard dialysis membranes and tends to accumulate within the musculoskeletal system<sup>1</sup>.</p><h4>Clinical presentation</h4><p>Shoulder pain and carpal tunnel syndrome are the most common clinical manifestations. Symptoms are commonly bilateral.</p><p>Patients can also develop osteolytic bone lesions (amyloidomas).</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Features of amyloid arthropathy are those of an erosive and destructive osteoarthropathy, involving most commonly the hips, shoulders and carpal bones. Distribution is frequently bilateral.</p><p>In the large joints, amyloid arthropathy resembles inflammatory arthritis with </p><ul>
- +<li>juxta-articular soft-tissue swelling(s) </li>
- +<li>mild periarticular osteoporosis, and</li>
- +<li>subchondral cystic lesions, usually with well-defined sclerotic margins</li>
- +<li>joint space is usually normal in width until late in the course of the disease</li>
- +</ul><p>Patients with <a href="/articles/amyloidoma">amyloidomas </a>of bone or with large subchondral lesions have a high prevalence of <a href="/articles/pathologic-fracture">pathologic fractures</a>. </p><h5>MRI</h5><p>The MR imaging appearance of amyloid infiltration within or around the joint consists of extensive deposition of an abnormal soft tissue that has </p><ul>
- +<li>
- +<strong>T1 </strong>: low or intermediate signal intensity </li>
- +<li>
- +<strong>T2</strong> : low to intermediate signal intensity</li>
- +</ul><p>This abnormal material covers the synovial membrane, fills subchondral defects, and extends to periarticular soft tissue. Joint effusion is usually present.</p><h4>Differential diagnoses</h4><p>Differential for multiple lytic bone lesions include:</p><ul>
- +<li>metastases</li>
- +<li><a href="/articles/multiple-myeloma-1">multiple myeloma</a></li>
- +</ul><p>However, the peri-articular distribution is a distinguishing feature.</p>
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