Erosive azotemic osteoarthropathy of the hands in chronic ambulatory peritoneal dialysis and hemodialysis.
OBJECTIVE
We studied the prevalence and significance of erosive azotemic osteoarthropathy (EAO) and its relationship with other osteoarticular abnormalities of dialysis-associated arthropathy (DAA).


METHODS
112 patients undergoing maintenance dialysis were studied: 63 hemodialysis (HD) and 49 continuous ambulatory peritoneal dialysis (CAPD). X-ray of the hands, shoulders, pelvis and cervical spine were examined for destructive spondyloarthropathy (SDA), bone cysts (BC), EAO and subperiosteal resorption. Beta 2-microglobulin (beta 2-m) and PTH were also measured.


RESULTS
Fifteen patients (13%) had EAO, usually in several joints of the hands, DIPs being the most frequently affected. Both patients on HD and those on CAPD had EAO, although the prevalence was higher in the HD group, 12 (19%) vs. 3 (6%). Patients with EAO were older (p < 0.05) and had more carpal tunnel syndrome (CTS) (p < 0.05) and BC (p < 0.01). Only 3 out of 15 patients with EAO had severe secondary hyperparathyroidism (sHPTH) (PTH > 500), while 9/15 had neither radiologic nor laboratory evidence of sHPTH. No differences were found regarding the duration of dialysis, or beta 2-m or PTH level.


CONCLUSIONS
EAO is not related to sHPTH and should be included within the spectrum of the clinical manifestations of DAA. Due to its location and radiologic picture, it is possible that etiologic factors leading to primary osteoarthritis may play a role in the development and evolution of EAO.
Gonzalez
T
T
Rheumatology Unit, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Spain.
Cruz
A
A
Balsa
A
A
Jiménez
C
C
Selgas
R
R
Miguel
J L
JL
Gijón
J
J
D000328:Adult; D000368:Aged; D001175:Arthrography; D002118:Calcium / Q000097:blood; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010758:Phosphorus / Q000097:blood; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D014511:Uremia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D001613:beta 2-Microglobulin / Q000378:metabolism
D010281:Parathyroid Hormone; D001613:beta 2-Microglobulin; D010758:Phosphorus; D002118:Calcium