Destructive spondyloarthropathy (DSA) has recently been recognized in hemodialysis patients. This study was undertaken to assess the prevalence, preferred sites, risk factors, early radiological manifestations, magnetic resonance imaging (MRI) and relation to other radiological features and biochemical variables in DSA. In 405 patients undergoing dialysis for 0.2-20.5 years (average 8.2) with a mean age of 51.9 years (range 24-84), a diagnosis of DSA was made for 37 (9.1%). The preferred site of DSA was the lower cervical spine. MRI indicated a low signal intensity of the involved vertebral regions on both T1- and T2-weighted images and thus appeared useful in the exclusion of osteomyelitis showing high-intensity T2-weighted images. The patients were divided into three groups according to radiological findings: those showing (A) the presence of DSA, (B) vertebral rim erosion (VRE) without DSA, and (C) the absence of DSA and VRE. Patient age at onset of dialysis (p less than 0.01) and duration of hemodialysis (p less than 0.05) appeared to be the associated risk factors for DSA. DSA was found correlated with carpal tunnel syndrome (p less than 0.01), carpal bone cystic radiolucency (p less than 0.01), and amyloid deposit (p less than 0.01). All the groups were essentially the same with respect to the incidence of ectopic calcification, secondary hyperparathyroidism, biochemical markers and sex distribution. The results of this study show DSA to be associated with dialysis amyloidosis.