EROSIVE AZOTEMIC OSTEOARTHROPATHY OF THE HANDS IN CHRONIC AMBULATORY PERITONEAL-DIALYSIS AND HEMODIALYSIS

Objective: We studied the prevalence and significance of erosive azote mic osteoarthropathy (EAO) and its relationship with other osteoarticu lar abnormalities of dialysis-associated arthropathy (DAA). Methods: 1 12 patients undergoing maintenance dialysis were studied. 63 hemodialy sis (HD) and 49 continuous ambulatory peritoneal dialysis (CAPD). X-ra y of the hands, shoulders, pelvis and cervical spine were examined for destructive spondyloarthropathy (SDA), bone cysts (BC), EAO and subpe riosteal 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 pat ients on HD and those on CAPD had EAO, although the prevalence was hig her 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 B C (p < 0.01). Only 3 out of 15 patients with EAO had severe secondary hyperparathyroidism (sHPTH) (PTH > 500), while 9/15 herd neither radio logic nor laboratory evidence of sHPTH. No differences were found rega rding the duration of dialysis, or beta 2-m or PTH level. Conclusion: EAO is not related to sHPTH and should be included within the spectrum of the clinical manifestations of DAA. Due to its location and radiol ogic picture, it is possible that etiologic factors leading to primary osteoarthritis may play a role in the development and evolution of EA O.