Uğur ÖZDEMİR, Derya KAŞKARİ, Ahmet Eftal YÜCEL

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

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

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

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.

Keywords:

Destructive spondyloarthropathy, hemodialysis, beta2-microglobulin, kidney failure,

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