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Sonographic subclinical entheseal involvement in dialysis patients

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Abstract

Long-term dialysis treatment can be associated with several musculoskeletal complications. Entheseal involvement in dialysis patients remains rarely studied as its prevalence is underestimated due to its often asymptomatic presentation. The aims of the study were to determine the prevalence of subclinical enthesopathy in haemodialysis and peritoneal dialysis patients at the lower limb level, to investigate the inter-observer reliability of ultrasound assessment and to analyse the influence of biometric and biochemical parameters. Ultrasound examination was conducted at the entheses of the lower limbs level in 33 asymptomatic dialysis patients and 33 healthy adopting the Glasgow Ultrasound Enthesitis Scoring System (GUESS). The inter-observer reliability was calculated in 15 dialysis patients. Ultrasound found at least one sign of enthesopathy in 165 out of 330 (50%) entheses of dialysis patients. In healthy subjects, signs of enthesopathy were present in 54 out of 330 (16.3%) entheses (p < 0.0001). No power Doppler signal was detected in healthy controls, in contrast to four of 330 entheses of dialysis patients. No US signs of soft tissue amyloid deposits were found. The GUESS score was significantly higher in dialysis patients than in controls (p < 0.0001). There was no difference in terms of enthesopathy between haemodialysis and peritoneal dialysis. Dialysis duration resulted to be the most important predictor for enthesopathy (p = 0.0004), followed by patient age (p = 0.02) and body mass index (p = 0.035). Parathormone, calcium, phosphorus, C-reactive protein, cholesterol and triglycerides apparently did not play a relevant role in favour of enthesopathy. The inter-observer reliability showed an excellent agreement between sonographers with different degree of experience. Our results demonstrated a higher prevalence of subclinical enthesopathy in both haemodialysis and peritoneal dialysis patients than in healthy subjects. Follow-up will provide further information with respect to the predictive value of US findings for the development of symptomatic dialysis-related arthropathy.

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References

  1. Bardin T, Zingraff J, Shirahama T et al (1987) Hemodialysis-associated amyloidosis and beta-2 microglobulin. Clinical and immunohistochemical study. Am J Med 83:419–424

    Article  PubMed  CAS  Google Scholar 

  2. Kiss E, Keusch G, Zanetti M et al (2005) Dialysis-related amyloidosis revisited. Am J Roentgenol 185:1460–1467

    Article  Google Scholar 

  3. Shiota E, Tsuchiya K, Yamaoka K et al (2002) Spontaneous major tendon ruptures in patients receiving long-term hemodialysis. Clin Orthop Relat Res 394:236–242

    Article  PubMed  Google Scholar 

  4. Escobedo EM, Hunter JC, Zink-Brody GC et al (1996) Magnetic resonance imaging of dialysis-related amyloidosis of the shoulder and hip. Skeletal Radiol 25:41–48

    Article  PubMed  CAS  Google Scholar 

  5. Asencio G, Rigout C, Ramparez P et al (1995) Hemodialysis-related lesions of the hand. Rev Rhum Engl Ed 62:233–240

    PubMed  CAS  Google Scholar 

  6. Jones N, Kjellstrand CM (1996) Spontaneous tendon ruptures in patients on chronic dialysis. Am J Kidney Dis 28:861–866

    Article  PubMed  CAS  Google Scholar 

  7. Meneghello A, Bertoli M (1983) Tendon disease and adjacent bone erosion in dialysis patients. Br J Radiol 56:915–920

    Article  PubMed  CAS  Google Scholar 

  8. Kurer MH, Baillod RA, Madgwick JCA (1991) Musculoskeletal manifestations of amyloidosis. J Bone Joint Surg 73:271–276

    CAS  Google Scholar 

  9. Calin A, Mackay K, Santos H, Brophy S (1999) A new dimension to outcome: application of the Bath Ankylosing Spondylitis Radiology Index. J Rheumatol 26:988–992

    PubMed  CAS  Google Scholar 

  10. Resnick D, Niwayama G (1983) Entheses and enthesopathy. Anatomical, pathological, and radiological correlation. Radiology 146:1–9

    PubMed  CAS  Google Scholar 

  11. D’Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M (2003) Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum 48:523–533

    Article  PubMed  Google Scholar 

  12. de Miguel E, Cobo T, Muñoz-Fernández S et al (2009) Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis 68:169–174

    Article  PubMed  Google Scholar 

  13. Gisondi P, Tinazzi I, El-Dalati G et al (2008) Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study. Ann Rheum Dis 67:26–30

    Article  PubMed  CAS  Google Scholar 

  14. Gutierrez M, Filippucci E, De Angelis R et al (2010) Subclinical entheseal involvement in patients with psoriasis: an ultrasound study. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2010.05.009 [Epub ahead of print]

    PubMed  Google Scholar 

  15. Takahishi T, Kato A, Ikegaya N et al (2002) Ultrasound changes of the carpal tunnel syndrome in patients receiving long-term hemodialysis: a cross-sectional and longitudinal study. Clin Nephrol 3:230–236

    Google Scholar 

  16. Jadoul M, Malghem J, Vande Berg B, van Ypersele de Strihou C (1993) Ultrasonographic detection of thickened joint capsules and tendons as marker of dialysis-related amyloidosis: a cross-sectional and longitudinal study. Nephrol Dial Transplant 8:1104–1109

    PubMed  CAS  Google Scholar 

  17. Ikegaya N, Hishida A, Sawada K et al (1995) Ultrasonographic evaluation of the carpal tunnel syndrome in hemodialysis patients. Clin Nephrol 44:231–237

    PubMed  CAS  Google Scholar 

  18. Lanteri M, Ptasznik R, Constable L, Dawborn JK (1997) Ultrasound changes in the wrist and hand in hemodialysis patients. Clin Nephrol 48:375–380

    PubMed  CAS  Google Scholar 

  19. Kay J, Benson CB, Lester S et al (1992) Utility of high-resolution ultrasound for the diagnosis of dialysis-related amyloidosis. Arthritis Rheum 35:926–932

    Article  PubMed  CAS  Google Scholar 

  20. McMahon LP, Radfor J, Dawborn JK (1991) Shoulder ultrasound in dialysis related amyloidosis. Clin Nephrol 35:227–232

    PubMed  CAS  Google Scholar 

  21. Buckwalter CE, KA BEM, Raymond-Tremblay D, Benson MD (1996) Amyloidosis of the shoulder in patients on chronic hemodialysis: sonographic findings. AJR 166:153–156

    PubMed  Google Scholar 

  22. Coari G, Iagnocco A, Maggi S (1996) Sonographic findings in haemodialysis-related chronic arthropathy. Eur Radiol 6:890–894

    Article  PubMed  CAS  Google Scholar 

  23. Dervisoglu E, Anik Y, Erdogan S, Akansel G, Yilmaz A (2008) Beta2-microglobulin amyloidosis in hemodialysis and peritoneal dialysis patients. Ther Apher Dial 12:306–310

    Article  PubMed  Google Scholar 

  24. McMahon LP, Radford J, Dawborn JK (1991) Shoulder ultrasound in dialysis related amyloidosis. Clin Nephrol 35:227–232

    PubMed  CAS  Google Scholar 

  25. Balint PV, Kane D, Wilson H et al (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61:905–910

    Article  PubMed  CAS  Google Scholar 

  26. Bianchi S, Martinoli C, Abdelwahab IF (2005) Ultrasound of tendon tears. Part 1: general considerations and upper extremity. Skeletal Radiol 34:500–512

    Article  PubMed  Google Scholar 

  27. Brountzos E, Syrgiannis K, Panagiotou I et al (2009) Ultrasonographic alterations in Achilles tendon in relation to parathormone in chronic hemodialysis patients. J Nephrol 22:476–483

    PubMed  CAS  Google Scholar 

  28. Kerimoglu U, Hayran M, Ergen BF et al (2007) Sonographic evaluation of enthesal sites of the lower extremity in patients undergoing hemodialysis. J Clin Ultrasound 35:417–423

    Article  PubMed  Google Scholar 

  29. Garbar C, Jadoul M, Noël H, van Ypersele de Strihou C (1999) Histological characteristics of sternoclavicular beta 2-microglobulin amyloidosis and clues for its histogenesis. Kidney Int 55:1983–1990

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Clinica Reumatologica, Università Politecnica delle Marche, Ospedale “A. Murri”, Via dei Colli, 52, 60035, Jesi, Ancona, Italy

    Marwin Gutierrez, Emilio Filippucci, Fausto Salaffi, Andrea Becciolini, Chiara Bertolazzi & Walter Grassi

  2. Unità Operativa di Nefrologia e Dialisi, Ospedale “A. Murri”, Jesi, Ancona, Italy

    Matthias Zeiler, Tania Monteburini, Rosa Maria Agostinelli, Rita Marinelli & Stefano Santarelli

  3. Departamento de Reumatologia, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico

    Mario Chavez

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  1. Marwin Gutierrez
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  2. Matthias Zeiler
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  3. Emilio Filippucci
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  4. Fausto Salaffi
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  8. Tania Monteburini
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  9. Rosa Maria Agostinelli
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  12. Walter Grassi
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Correspondence to Marwin Gutierrez.

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Gutierrez, M., Zeiler, M., Filippucci, E. et al. Sonographic subclinical entheseal involvement in dialysis patients. Clin Rheumatol 30, 907–913 (2011). https://doi.org/10.1007/s10067-011-1703-8

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  • DOI: https://doi.org/10.1007/s10067-011-1703-8

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