Destructive noninfectious spondyloarthropathy in hemodialysis patients: a report of four cases.

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Abstract
A rapidly progressive destructive spondyloarthropathy that resembles infectious spondylitis is reported in four patients undergoing long-term hemodialysis for chronic renal disease. Its characteristics are similar to those of a recently recognized entity reported in ten patients in the rheumatology literature. It is believed that the alterations represent a crystal-induced arthropathy because (a) these crystals are known to cause destructive arthropathy in extraspinal sites, (b) the association of crystal deposits and chronic renal disease in patients undergoing dialysis is well recognized, and (c) calcium hydroxyapatite and calcium pyrophosphate have been recovered from biopsy material in two of the reported 14 cases. Patients with chronic renal disease in whom a rapidly destructive spinal arthropathy develops should have a biopsy of the affected area to exclude infection. Because a crystal-induced destructive process may simulate infection, crystalline analysis should also be performed on the biopsy material.

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