Abstract
Prolonged survival of patients in chronic renal failure managed by haemodialysis patients has led to recoginition of various osteoarticular and soft tissue complications. Since Kuntz first reported a new syndrone, destructive spondyloarthropathy (DSA) in haemodialysis (HD) patients in 1984, an increasing number of patients have been refered for surgery. We studied clinical and radiographical feature of 20 DSA cases in 114 patients received haemodialysis over 5 years.
There were 69 men and 45 women aged from 34 to 85 years, average 58 years. The average period of HD was 11.8 years (range from 5 to 21 years). Twenty patients were diagnosed with DSA (17.5%) according to Tanisawa classification. Nine men and 11 women aged from 42 to 83 years, average 63.7 years. An average period of HD was 13.1 years (range from 5 to 20 years). DSA was identified in the following vertebrae: 1 in patient in C1/2, 2 in C3/4, 4 in C4/5, 4 in C5/6, 5 in C6/7, 1 in C1/2 C5/6, 2 in C4/5 C5/6, 1 in C3/4 C5/6, Complications included carpal tunnel syndrome in 7 patients, and secondary hyperparathyroidism in 6 patients. There was no significant difference in biochemical analysis between the DSA group and the non DSA group. The DSA group was significantly older than the non DSA group (p<0.01). Eighteen patients had no complaint, but 2 patients had slight neck pain. These results indicate that there were many latent case of DSA in the long term dialysis group. Without regular radiological surveys, these patients may not receive conservative treatment until they complain of pain. Early identification and intervention may prevent the development of extreme instability, and possibly avoid surgery.
