Which spondyloarthropathy is unique to dialysis patients

Which spondyloarthropathy is unique to dialysis patients?

destructive spondyloarthropathy (DSA) is found only in long-term patients on dialysis and is defined by its radiologic picture. It can mimic an infectious discitis. There is multilevel disc-space narrowing with erosions and cysts of adjacent vertebral endplates without significant osteophytosis or sclerosis. Calcification of surrounding vertebral discs is common. The cervical and lumbar spine are most frequently involved. The erosions progress radiographically over a few weeks or more, followed by reactive endplate sclerosis. Diffuse spinal involvement is unusual, although multisegment involvement has been described.

This entity has been reported occasionally in patients who are uremic before dialysis but has not been reported following renal transplantation. Most patients are asymptomatic, which accounts for the rarity of its description. Neck pain or cervical radiculopathy is the most common complaint in symptomatic patients. Despite the severe radiologic picture, medullary compression is rare. Biopsies reveal calcium crystals (CPDD or hydroxyapatite) and/or β2-microglobulin. Hyperparathyroidism is usually also present and appears to play a role in the pathogenesis of DSA. Control of hyperparathyroidism, including subtotal parathyroidectomy, helps to slow down the progression of DSA.


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