During Orthopedic Surgery, Musculoskeletal Pathology May Help Signal Systemic Amyloidosis

Amyloid deposition in a range of end-organ systems can be caused by transthyretin (TTR) and immunoglobulin light-chain amyloidosis (AL). Orthopedic conditions may harbor soft tissue amyloid deposits prior to manifestations in the cardiac setting. Because amyloid deposition in these patients may be reduced through pharmacologic interventions and appropriate treatment, long-term survival may be improved through early diagnosis.

Researchers conducted a systematic review to assess the potential connection between amyloid deposition and musculoskeletal pathology in patients with common orthopedic conditions. The researchers intended to determine whether there was a connection between amyloid positive biopsy in musculoskeletal tissue and subsequent diagnosis of systemic amyloidosis.

Wininger and colleagues performed a systematic review using articles that analyzed light-chain or transthyretin amyloid deposits in common orthopedic surgeries.

PubMed, Scopus, Web of Science, and Google Scholar database searches resulted in 3944 unique abstracts. After screening, the majority (3812) of these abstracts did not meet the study inclusion criteria. Ultimately, 24 studies were included in the final analysis, comprising 3606 participants in total.

In 5 musculoskeletal pathologies, amyloid deposition was reported; these pathologies included hip and knee osteoarthritis (synovium and articular cartilage), lumbar spinal stenosis (ligamentum flavum), carpal tunnel syndrome (transverse carpal ligament and flexor tenosynovium), and rotator cuff tears (tendon). A mean age >70 years for patients with TTR or AL positive amyloid was reported by the majority of studies.

The investigators found that at the time of common orthopedic surgeries the presence of amyloid deposition was detected, and this was particularly true in patients aged ≥70 years. Findings from this study may warrant increased clinical vigilance to enable amyloid subtyping, which may facilitate systemic light-chain or transthyretin amyloidosis diagnosis prior to cardiac manifestations.

Source: Wininger AE, Phelps BM, Le JT, et al. Musculoskeletal pathology as an early warning sign of systemic amyloidosis: a systematic review of amyloid deposition and orthopedic surgery. BMC Musculoskelet Disord. 2021;22:51.

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