Spondyloarthropathy from long-term hemodialysis.

Abstract

Twenty-six patients undergoing long-term hemodialysis who had hand and wrist abnormalities were examined for the presence of concurrent spinal disease. Six patients (23%) were found to have spinal disease on radiographs. In four, the findings resembled those of a destructive spondyloarthropathy, and in two, a less destructive erosive arthritis. A review of the spinal radiographs of 31 patients with normal hands and wrists revealed no such abnormalities. Postmortem examinations of two patients with spondyloarthropathy demonstrated extensive deposition of beta-2 microglobulin, an amyloid-like substance. The authors conclude that the disease is similar in both areas and represents a skeletal response to chronic renal failure and long-term hemodialysis. The disease may occur more frequently with an increased duration of hemodialysis, in one area of the skeleton if another area is already affected, and is probably not infectious if multiple areas are involved.

Pseudotumor of the craniocervical junction during long‐term hemodialysis

“…A chronic arthropathy that predominantly involves the shoulders and is frequently associated with amyloid carpal tunnel syndrome (CTS), subchondral bone cysts or erosions, and destructive arthropathies has recently been described in such patients (2). The cervical spine is frequently involved in this erosive process, and there are numerous reports of a destructive spondylarthropathy of the cervical spine (3)(4)(5)(6)(7)(8)(9)(10). However, the craniovertebral junction has not been extensively investigated, despite the risk of severe neurologic complications associated with lesions at this site.…”

Surgical Treatment with Instrumentation for Severely Destructive Spondyloarthropathy of Cervical Spine

“…17,18 Mechanical factors also seem to be important, as the disease predominantly affects the most mobile segments of both the cervical and the lumbar spine. 1,3,[19][20][21] One of the biologic characteristics of ␤2-microglobulin is a strong affinity to collagen fibers. 6,22,23 Ohashi et al 6 reported a possible relationship between disc degeneration and deposition of ␤2-microglobulin and stated as their opinion that quantitative and qualitative changes of collagen and glycosaminoglycan in the degenerative discs were the main factors enhancing the affinity of ␤2-microglobulin to the discs.…”

Beta-2-Microglobulin-Associated Amyloidosis

“…A second form is more destructive, with bone fragmentation and soft tissue involvement [38,39]. A third form can present with erosions and/or destructive changes of the intervertebral disc space [40], Destructive spondylarthropathy has also been noted in uremic patients prior to the onset of hemodialysis as well as in patients treated with peritoneal dialysis [5,[41][42][43][44], While it was initially assumed that destructive spondy larthropathy in long-term hemodialysis patients was due to the deposition of hydroxyapatite crystals [37], it may also be associated with other clinical problems, including hyperparathyroidism, AP2M amyloid deposition, and alu minium intoxication [45]. Furthermore, it should be kept in mind that age-associated amyloid deposits that are unrelated to AP2M type amyloid may be found in inter vertebral discs and articular cartilage [46,47], The role of AP2M amyloid, however, in the pathogenesis of spondyl arthropathy has been emphasized by Sebert et al [48] and recently AP2M deposits, located preferentially in cervical discs, were demonstrated in a large series of renal failure autopsy cases [49].…”