Hemodiyaliz Tedavisi Almakta Olan Son Dönem Böbrek Yetmezliği Olan Hastalarda Spondiloartropati sıklığı

Yıl 2023, Cilt: 56 Sayı: 1, 6 - 10, 30.04.2023

Uğur Özdemir , Derya Kaşkari , Ahmet Eftal Yücel

https://doi.org/10.20492/aeahtd.1088143

Öz

Amaç: Spondiloartropati (SpA), renal replasman tedavisi (RRT) alan son dönem böbrek yetmezliği (SDBY) olan hastalarda beta2-mikroglobulin (beta2-M) birikimi nedeniyle özellikle aksiyal eklemlerin enflamatuar yıkımına bağlı olarak gelişir. Bu çalışmada, RRT alan SDBY hastalarında SpA sıklığını ve bunun enflamatuar sırt ağrısı (ESA) ile enflamatuar klasik SpA tanı kriter setleri ile olan ilişkisi araştırılmıştır.
Materyal ve metod: Toplam 140 hemodiyaliz tedavisi ile takip edilmekte olan hasta dahil edildi. Hastalardan demografik bilgiler, laboratuvar testleri, klinik bulgular, HLA (insan lökosit antijen) allel alt gruplarının verileri toplandı. SpA'ya bağlı ağrısı olan hastalarda sakroiliak ve ayak lateral grafileri ve tanı netleştirilemeyen hastalardan gerekirse sakroiliak tomografi çekildi. SpA sıklığı, Amor ve ESSG (The European Spondyloarthropathy Study Group) tanı kriter setlerine göre araştırıldı.
Sonuçlar: Elli iki hasta (%37) kadındı. Ortanca yaş 51 ± 15 idi. Hastaların 22'sinde ESA ve 28'inde sakroiliit saptandı. CRP açısından ESA’ya ve sakroiliite göre anlamlı fark vardı (p=0.028, p=0.043). 21 (%15) hastada SpA tespit edildi. HLA-A1 varlığı ve HD süresi SpA için bağımsız risk faktörleri olarak belirlendi.
Sonuç: SDBY olan ve HD tedavisine girmekte olan hastalarda SpA tanısında radyolojik kriterlere ek olarak ağrının enflematuvar karakterde olup olmadığı ve enflamatuar belirteçler araştırılmalıdır.

Anahtar Kelimeler

Destürkitif spondiloartropati, hemodiyaliz, beta2-mikroglobulin, böbrek yetersizliği

Destekleyen Kurum

Bulunmamakta

Frequency of spondyloarthropathy in patients with end-stage chronic renal failure and receiving renal replacement therapy (hemodialysis)

Öz

Objectives: Destructive spondyloarthropathy (dSpA) occurs due to inflammatory destruction of axial joints due to beta2-microglobulin (beta2-M) accumulation in patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT). This study aimed to investigate the frequency of dSpA in ESRD patients receiving RRT, by the diagnostic criteria sets of inflammatory back pain (IBP) and inflammatory classical SpA.
Methods: A total of 140 patients were included. The data of the demographic informations, laboratory tests, clinical findings, HLA allele subgroups were collected. Sacroiliac and lateral feet X-rays and if necessary sacroiliac tomography were taken in patients with dSpA related pain. dSpA was investigated according to the Amor and ESSG criteria sets.
Results: Fifty two patients were women (37%). The mean age was 51 ± 15 years. IBP and sacroiliitis were detected in 22 and 28 of the patients, respectively. There was a significant difference according to sacroiliitis and IBP in terms of CRP (p=0.028, p=0.043). dSpA were detected in 21 (15%) patients. Presence of HLA-A1 and duration of HD were determined as independent risk factors for dSpA.
Conclusions: In the diagnosis of dSpA, the character and inflammatory origin of the pain and inflammatory markers should be investigated in addition to the radiological criteria.

Anahtar Kelimeler

Destructive spondyloarthropathy, hemodialysis, beta2-microglobulin, kidney failure

Kaynakça

• 1. Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021,52:98-107. doi: 10.1159/000514550
• 2. Akgul O, Ozgocmen S. Classification criteria for spondyloarthropathies. World J Orthop. 2011,18:107-15. doi: 10.5312/wjo.v2.i12.07
• 3. Tsai TT, Kaliya-Perumal AK, Jenq CC, Niu CC, Ho NY, Lee TY, et al. The unresolved problem of beta-2 microglobulin amyloid deposits in the intervertebral discs of long-term dialysis patients. J Orthop Surg Res. 2017,12:194. doi: 10.1186/s13018-017-0697-6
• 4. Naito M, Ogata K, Nakamoto M, Goya T, Sugioka Y. Destructive spondylo-arthropathy during long-term haemodialysis. J Bone Joint Surg Br. 1992 Sep;74(5):686-90. doi: 10.1302/0301-620X.74B5.1527113
• 5. Hayami N, Hoshino J, Suwabe T, Sumida K, Mise K, Hamanoue S, et al. Destructive Spondyloarthropathy in Patients on Long-Term Peritoneal Dialysis or Hemodialysis. Ther Apher Dial. 2015,19:393-8. doi: 10.1111/1744-9987.12282
• 6. Hayami N, Hoshino J, Suwabe T, Sumida K, Mise K, Hamanoue S, et al. Destructive Spondyloarthropathy in Patients on Long-Term Peritoneal Dialysis or Hemodialysis. Ther Apher Dial. 2015,19:393-8. doi: 10.1111/1744-9987.12282
• 7. Niu CC, Chen WJ, Chen LH, Shih CH. Destructive spondyloarthropathy mimicking spondylitis in long-term hemodialysis patients. Arch Orthop Trauma Surg. 2000,120:594-7. doi: 10.1007/s004020000135.
• 8. Elder BD, Petteys RJ, Sciubba DM, Wolinsky JP. Challenges of cervical reconstruction for destructive spondyloarthropathy in renal osteodystrophy. J Clin Neurosci. 2016,30:155-7. doi: 10.1016/j.jocn.2016.02.005
• 9. Kaplan P, Resnick D, Murphey M, Heck L, Phalen J, Egan D, et al. Destructive noninfectious spondyloarthropathy in hemodialysis patients: a report of four cases. Radiology. 1987,162:241-4. doi: 10.1148/radiology.162.1.3786769
• 10. Rafto SE, Dalinka MK, Schiebler ML, Burk DL Jr, Kricun ME. Spondyloarthropathy of the cervical spine in long-term hemodialysis. Radiology. 1988,166:201-4. doi: 10.1148/radiology.166.1.3336679
• 11. Scarpioni R, Ricardi M, Albertazzi V, De Amicis S, Rastelli F, Zerbini L. Dialysis-related amyloidosis: challenges and solutions. Int J Nephrol Renovasc Dis. 2016,9:319-28. doi: 10.2147/IJNRD.S84784
• 12. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984,27:361-8. doi: 10.1002/art.1780270401
• 13. Toumi H, Davies R, Mazor M, Coursier R, Best TM, Jennane R, et al. Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic. BMC Musculoskelet Disord. 2014,15:87. doi: 10.1186/1471-2474-15-87
• 14. Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019,1165:3-15. doi: 10.1007/978-981-13-8871-2_1
• 15. Scarpioni R, Ricardi M, Albertazzi V, De Amicis S, Rastelli F, Zerbini L. Dialysis-related amyloidosis: challenges and solutions. Int J Nephrol Renovasc Dis. 2016,9:319-28. doi: 10.2147/IJNRD.S84784
• 16. Kaneko S, Yamagata K. Hemodialysis-related amyloidosis: Is it still relevant? Semin Dial. 2018,31:612-8. doi: 10.1111/sdi.12720
• 17. Hou FF, Jiang JP, Guo JQ, Wang GB, Zhang X, Stern DM, et al. Receptor for advanced glycation end products on human synovial fibroblasts: role in the pathogenesis of dialysis-related amyloidosis. J Am Soc Nephrol. 2002,13:1296-306. doi: 10.1681/ASN.V1351296
• 18. Schaeffer J, Floege J, Ehlerding G, Koch KM. Pathogenetic and diagnostic aspects of dialysis-related amyloidosis. Nephrol Dial Transplant. 1995,3:4-8. doi: 10.1093/ndt/10.supp3.4
• 19. Chikawa T, Sakai T, Bhatia NN, Miyagi R, Sairyo K, Goda Y, et al. Clinical outcomes of spinal surgery in patients treated with hemodialysis. J Spinal Disord Tech. 2013,26:321-4. doi: 10.1097/BSD.0b013e318246af73
• 20. Kessler M, Netter P, Azoulay E, Mayeux D, Pere P, Gaucher A. Dialysis-associated arthropathy: a multicentre survey of 171 patients receiving haemodialysis for over 10 years. The Co-operative Group on Dialysis-associated Arthropathy. Br J Rheumatol. 1992,31:157-62. doi: 10.1093/rheumatology/31.3.157
• 21. Hayami N, Hoshino J, Suwabe T, Sumida K, Mise K, Hamanoue S, et al. Destructive Spondyloarthropathy in Patients on Long-Term Peritoneal Dialysis or Hemodialysis. Ther Apher Dial. 2015,19:393-8. doi: 10.1111/1744-9987.12282
• 22. Maruyama H, Gejyo F, Arakawa M. Clinical studies of destructive spondyloarthropathy in long-term hemodialysis patients. Nephron. 1992,61:37-44. doi: 10.1159/000186832
• 23. Chen J, Yang F, Zhang Y, Fan X, Xiao H, Qian W, et al. HLA-A*01:01 in MHC is associated with psoriatic arthritis in Chinese Han population. Arch Dermatol Res. 2019,311:277-85. doi: 10.1007/s00403-019-01902-3
• 24. Henry CH, Nikaein A, Wolford LM. Analysis of human leukocyte antigens in patients with internal derangement of the temporomandibular joint. J Oral Maxillofac Surg. 2002,60:778-83. doi: 10.1053/joms.2002.33245
• 25. Salvarani C, Macchioni PL, Zizzi F, Mantovani W, Rossi F, Baricchi R, et al. Clinical subgroups and HLA antigens in Italian patients with psoriatic arthritis. Clin Exp Rheumatol. 1989,7:391-6