Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151825 (bone pain)
 3,118 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bone and joint pathology in patients undergoing long-term dialysis for end-stage renal failure is presented in the light of typical cases and a brief review of the literature. Osteomalacia with bone pain and fractures is caused mainly by aluminium overload due to enteral uptake from aluminium-containing phosphate binders. This is why calcium acetate or calcium carbonate should be used exclusively to lower enteral phosphate reabsorption. If--due to hypercalcemia--aluminium containing phosphate binders--cannot be entirely avoided, they should never be administered together with citrate (citrate-containing medication, fruit juice, etc.), which chelates aluminium and thereby massively increases enteral aluminium uptake. Secondary hyperparathyroidism with overt radiologically demonstrable bone disease develops in many patients on long-term dialysis despite efforts to maintain plasma calcium within or slightly above the upper normal range and concomitant treatment with calcitriol. Intravenous administration of relatively high-dose calcitriol or 1-alpha-OH-D3 (neither readily available at the present time), as well as the newly developed experimental vitamin D analogs such as 22-oxa-(OH)2-D3, which appear to suppress the parathyroid glands without increasing enteral calcium reabsorption, may in future reduce the high incidence of parathyroidectomy in patients on maintenance dialysis. beta 2-microglobulin amyloidosis is a new disease entity which develops in the majority of long-term dialysis patients. Apart from carpal tunnel syndrome, trigger fingers and tendon ruptures, it is associated with acute and chronic painful erosive arthropathy with joint effusions and fractures, particularly around the hip, due to cystic bone lesions where bone is replaced by nodular amyloid deposits.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Bone and joint problems in long-term dialysis]. 159 6

Using radioimmunological estimation of beta 2-microglobulin (beta 2M), significantly greater serum values were found in 36 dialysis patients (44.4 +/- 20.3 mg/l) in comparison to healthy probands (1.5 +/- 0.2 mg/l). A significant relation to the duration of dialysis, diuresis and serum aluminium and ferritin was found. The used dialysers MLW 1.3/1.8 m2 (regenerated cellulose membrane) did not eliminate beta 2M from the blood. Significantly greater beta 2M concentrations were observed in patients suffering from arthralgia and bone pain, but not in radiologically verified arthropathy and destructive spondylarthropathy. Post-mortem examinations of 13 patients on haemodialysis treatment for between 10 and 90 months revealed synovial beta 2M-derived (AB-)amyloid deposits in four patients at different joints, but not in radiologically suspect areas. The results suggest that independent of serum beta 2M, beta 2M-derived amyloidosis may occur in elderly patients on dialysis for less than 5 years. Several cases were completely asymptomatic.
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PMID:Beta 2-microglobulin serum concentration and associated amyloidosis in dialysis patients. 177 70

Despite recent improvements of hemodialysis (HD) techniques, symptoms due to secondary hyperparathyroidism (HPT) contribute to longtime complications of HD patients. The aim of the present retrospective study was to determine the incidence and localization of radiological joint and bone lesions in 175 patients on chronic HD. In 108 patients the diagnosis of HPT was made by radiologic criteria. 56% had radiomorphologic lesions of the hands, 45% of the acromio-clavicular (AC) joint, 31% of the shoulder, and 27% of the pelvis. No sex difference was found for prevalence of HPT in these patients, nor was one found for any of the underlying renal diseases. There was a negative correlation between elevated serum parathyroid hormone and serum aluminum concentrations. In 111 patients the history of bone and joint pain was evaluated. 54% of these patients suffered from bone pain, arthralgia, and morning stiffness. Radiological lesions of AC-joint correlated with shoulder pain in 38%. Our data show that even in the predialytic phase of renal insufficiency x-rays of the shoulder are helpful in early diagnosis of HPT. Skeletal manifestations specific for one of the underlying renal diseases do not exist. Elevated PTH levels are a good indicator of HPT in these patients, whereas low levels of PTH do not exclude radiological manifestations. In contrast to beta 2-microglobulin amyloidosis, pain does not occur during rest and is not worsened during HD. Treatment with non-steroidal antiinflammatory drugs led to pain relief in the majority of patients. Pain history in patients on chronic HD provides important information concerning the differential diagnosis of HPT/beta 2-microglobulin amyloidosis.
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PMID:[Rheumatologic and radiologic symptoms of secondary hyperparathyroidism: retrospective long-term study of 175 chronic hemodialysis patients]. 177 68

The purpose of this study was to analyse the presenting clinical and laboratory features and the outcome of 72 patients with multiple myeloma (MM) who were younger than 40 years. The records of all Mayo Clinic patients with MM younger than 40 years who were seen between 1 January 1956 and 31 December 1992 were reviewed. Survival was measured from the date when treatment was required to the date of last follow-up or death. The frequency of MM in patients younger than 40 and 30 years in 3278 Mayo Clinic patients was 2.2% and 0.3%, respectively. The main presenting clinical features were bone pain (66%), fatigue (26%), extramedullary plasmacytomas (19%) and bacterial infection (11%). Renal function impairment (creatinine level > or = 177 micromol/l) and hypercalcaemia (serum calcium value > or = 2.75 mmol/l) occurred in 29% and 30% of patients, respectively. Among the 57 patients evaluable for response the objective response rate was 54%. 14/35 patients treated with a single alkylating agent achieved an objective response, whereas 17/22 patients given combination chemotherapy had an objective response (P=0.013). However, this higher response rate did not result in a significantly longer survival. The median survival for the 72 patients was 54 months. Patients with good prognostic features (normal renal function or low beta 2-microglobulin level) had a median survival of 8 years. The actuarial survival at 5 and 10 years after initiation of therapy was 43% and 13%, respectively. In summary, survival in very young patients with myeloma is longer than that observed in series of patients of all ages, especially in those with good prognostic factors.
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PMID:Presenting features and prognosis in 72 patients with multiple myeloma who were younger than 40 years. 863 27

We investigated the incidence of bone lesions in elderly cases of multiple myeloma (MM) and the course of those lesions, and also evaluated the relationships of skeletal symptoms with prognostic factors, and prognosis. The subjects were 146 patients, aged 65 years or more (median age 74, range 65-97 year), who were admitted to 11 institutions between January, 1988 and December, 1997. They consisted of 64 men and 82 women. The disease type was IgG type in 88 patients, IgA type in 37 patients, Bence-Jones (BJ) type in 17 patients, IgD type in three patients, and non-secretory type in one patient. Bone lesions in elderly MM patients were compared with those in 65 non-elderly MM patients. Skeletal symptoms were noted in 104 patients, and bone pain in 75 patients at the time of diagnosis. The bone lesions were evaluated as only osteolytic lesions in 26 patients, osteolytic lesions + osteoporosis in 23 patients, only osteoporosis in 2 patients and pathologic bone fractures in 53 patients. The occurrence rate of osteoporosis plus osteolytic lesion was higher in elderly patients (63.5%) than that in non-elderly patients (NE-MM group) (28.3%) (p < 0.0001). The bone lesions were most often observed in lumbar vertebrae (58.7%), cranial bone (56.7%), thoracic vertebrae (40.4%) and ribs (27.9%). The occurrence rate of bone lesion in lumbar vertebrae was higher in elderly patients (58.7%) than that in non-elderly patients (22.6%) (p < 0.0001). The life activities were limited in 71 patients because of the bone lesions. The relationship between the prognostic factors of MM and bone lesions was evaluated. There was a significant difference in the serum Ca level between patients with and without bone pain (P < 0.0001) and between those with and without pathologic bone fracture (P < 0.01). There was a significant difference in the appearance rate of plasma cells in the bone marrow between the patients with and without bone lesions (P < 0.05), between those with and without bone pain (P < 0.01), and between those with and without pathologic fracture (P < 0.05). There was a significant difference in the serum beta 2-microglobulin level between the patients with and without bone pain, and between those with and without pathologic fracture. There were no significant differences in survival times between elderly MM patients with and without bone lesions, bone pain and pathological bone fractures, while significant differences of survival times were found between non-elderly MM patients with and without bone lesions, bone pain and pathological bone fractures (P < 0.05, each). These data suggest that there are some differences in bone lesions between elderly and non-elderly MM patients.
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PMID:[Bone lesions in elderly multiple myeloma]. 1251 15