Arthropathy in haemodialysed patients

Area of Science:

• Nephrology
• Rheumatology
• Orthopedics

Background:

• Osteodystrophy and joint disorders are common complications in patients undergoing regular hemodialysis.
• Uremic osteoarthropathy often presents with bone abnormalities as the primary issue, leading to secondary arthropathy.

Purpose of the Study:

• To review joint disorders associated with osteodystrophy in hemodialysis patients.
• To summarize signs, symptoms, and laboratory findings of uremic osteoarthropathy.
• To discuss current preventive and therapeutic strategies, emphasizing iontophoresis.

Main Methods:

• Review of 124 regularly hemodialyzed patients.
• Analysis of clinical signs and symptoms of osteoarthropathy.
• Evaluation of laboratory findings (calcium, phosphate, parathyroid hormone).
• Assessment of preventive and therapeutic measures.

Main Results:

• Common signs include calcification, pain, and stiffness; capsulitis, carpal tunnel syndrome, and avascular necrosis were also observed.
• Laboratory findings consistent with secondary hyperparathyroidism: hypocalcemia, hyperphosphatemia, and elevated parathyroid hormone.
• Iontophoresis with lidocaine and steroids shows promise as a therapeutic option.

Conclusions:

• Joint disorders in hemodialysis patients are often secondary to underlying bone disease (osteodystrophy).
• Comprehensive management addressing bone metabolism and joint symptoms is crucial.
• Combined local lidocaine and steroid iontophoresis may offer benefits for uremic osteoarthropathy.