Dialysis-related spondyloarthropathy☆☆☆★

Objective: To discuss a case of dialysis-related spondyloarthropathy due to β-2 microglobulin amyloid deposition. An emphasis is placed on the imaging findings. Clinical Features: A 67-year-old man sought treatment for low back pain. His history revealed coronary artery bypass surgery, diabetes with bilateral foot neuropathy, gout, and bilateral renal failure that had been treated with dialysis for 2 years before left renal transplantation; the renal transplant had been performed 6 years earlier. Radiography, computed tomography, and magnetic resonance imaging revealed changes characteristic of dialysis-related spondyloarthropathy. Intervention and Outcome: The patient was initially treated with physiotherapy. He was then admitted to the hospital and treated for renal infection and medicated for low back pain. Two weeks later he returned to the chiropractor, who began a treatment plan that included spinal manipulation, physiotherapy, manual distractive traction, and a gradual increase in activities of daily living. The patient was released from care after 2 months with significantly decreased pain. Conclusions: Dialysis-related spondyloarthropathy is a relatively uncommon complication of renal dialysis. It should be suspected in those patients who present with a correlative medical history and characteristic radiographic appearance. Chiropractic treatment can be effective as an adjunct to medical care in cases of chronic renal failure and associated complications. (J Manipulative Physiol Ther 2001;24:127-30)