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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Periarticular calcification mimicking inflammatory polyarthritis in chronic kidney disease
Kumari Naidoo1, Kwazi C Z Ndlovu2, Girish M Mody1
1Department of Rheumatology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
Insights
Periarticular calcification in chronic kidney disease (CKD) can mimic inflammatory arthritis. Poor adherence to CKD management worsened mineral imbalances, leading to these symptoms.
Area of Science:
- Nephrology
- Rheumatology
- Radiology
Background:
- Periarticular calcification is common in chronic kidney disease (CKD) but rarely presents as inflammatory periarthritis, tenosynovitis, or bursitis.
- CKD management involves dialysis, phosphate binders, Vitamin D, and antihypertension therapy.
Observation:
- A 34-year-old male with CKD on dialysis for three years presented with painful, swollen joints.
- He exhibited poor adherence to his prescribed CKD management regimen.
- Clinical examination revealed swelling in fingers and toes, wrist tenosynovitis, and olecranon bursitis.
Findings:
- Laboratory results indicated severe renal dysfunction (urea 36 mmol/L, creatinine 1764 umol/L) and mineral/bone disorder (corrected calcium 1.76 mmol/L, phosphate 4.32 mmol/L, PTH 104 pmol/L).
- Radiographs confirmed periarticular calcification at sites of inflammation.
- Inflammatory symptoms resolved with oral steroid treatment.
Implications:
- Deranged mineral and bone metabolism in CKD can manifest as periarticular calcification, clinically mimicking inflammatory polyarthritis.
- This case highlights the importance of adherence to CKD management to prevent complications.
- Early recognition and management of mineral imbalances are crucial in CKD patients presenting with joint inflammation.
Abstract:
Periarticular calcification is a frequent radiographic manifestation in chronic kidney disease (CKD). However, clinical presentation as inflammatory periarthritis, tenosynovitis, and bursitis is unusual. A 34-year-old man with CKD on dialysis for three years presented with painful swollen joints. His adherence to regular dialysis, phosphate binders, Vitamin D supplements, and antihypertension therapy was poor. He had swelling of the right thumb, index, and little fingers; periarticular swelling of the left middle finger and right little toe; and extensor tenosynovitis of the wrists and right olecranon bursitis. Laboratory investigations showed the following: urea 36 mmol/L; creatinine 1764 umol/L; serum urate 0.37 mmol/L; corrected calcium 1.76 mmol/L; phosphate 4.32 mmol/L; 25-dihydroxycholecalciferol 30 ng/mL; and parathyroid hormone 104 pmol/L. Radiographs showed periarticular calcification corresponding to the sites of inflammation. The inflammation resolved with oral steroids. In our patient, deranged mineral and bone metabolism contributed to periarticular calcification at multiple sites, mimicking inflammatory polyarthritis.
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