Spinal radiologic lesions suggestive of destructive spondylarthropathy were found in 10 patients on longterm hemodialysis. These lesions were characterized by severe narrowing of the intervertebral disc, associated with erosions and geodes of the adjacent vertebral plates without osteophytosis. In 9 of the 10 patients the lesions were located in the cervical spine, and in 1 patient, in the lumbar spine. Microbial spondylitis, degenerative disc disease, and destructive spondylarthropathy of calcium pyrophosphate dihydrate deposition disease were each, in turn, ruled out. The finding of apatite crystals by transmission electron microscopy in 1 disc specimen suggests that these crystals may be associated with destructive vertebral disc lesions in dialysis patients.Hemodialysis can considerably prolong the life span of patients suffering from terminal renal failure. However, it can lead t o various bone and joint complications. In addition to renal osteodystrophy, these complications include infections and acute arthritis or

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35 (p<0-05). No correlation between HLA antigens and intolerances to drugs was found in seronegative patients, whereas in seropositive patients side effects to gold salts were associated with DR3. These results suggest that seropositive and seronegative RA have distinct HLA-DR associations, especially in disease of early onset, in addition to well established clinical differences.

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