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Pairan MS, Abdul Halim S. Intracranial Aneurysm: A Rare Neurological Finding in Ankylosing Spondylitis. Cureus 2023; 15:e49509. [PMID: 38152807 PMCID: PMC10752629 DOI: 10.7759/cureus.49509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Ankylosing spondylitis can present with various extra-articular manifestations. Vascular complications due to aortic aneurysm or aortitis have been documented. However, an association with intracranial vascular aneurysm is rarely reported. We report a case of a young male with positive HLA B27 ankylosing spondylitis, with extra-articular involvements, presented with recurrent unilateral headache. He was found to have an unruptured anterior communicating artery aneurysm. It was confirmed by a cerebral angiogram, and he was treated conservatively.
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Affiliation(s)
| | - Sanihah Abdul Halim
- Department of Internal Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MYS
- Department of Brain and Behaviour Cluster, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan, MYS
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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Patelis N, Nana P, Spanos K, Tasoudis P, Brotis A, Bisdas T, Kouvelos G. The Association of Spondylitis and Aortic Aneurysm Disease. Ann Vasc Surg 2021; 76:555-564. [PMID: 33951524 DOI: 10.1016/j.avsg.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature. METHODS A systematic search was undertaken using MEDLINE, EMBASE and CENTRAL databases till May 2019, for articles reporting on patients suffering from spondylitis and aortic aneurysm. RESULTS The most involved aortic segment was infrarenal aorta (56.9%). The lumbar vertebrae were more frequently affected (79.7%). Commonest symptoms were back pain (79.1%), fever (33.7%) and lower limb pain (29.1%). 55.8% of cases were diagnosed using computed tomography. The pathology was attributed to infectious causes in 25.1% of cases. 53.4% of patients were treated only for the aneurysm, 27.9% for both pathologies, while two patients solely for the vertebral disease. Endovascular aneurysm repair was chosen in 12.8% of cases. The 30-day mortality was 8.1% (7/86); mostly from vascular complications. CONCLUSIONS A synchronous spondylitis and aortic aneurysm may share common etiopathology, when an infectious or inflammatory cause is presented. The lumbar vertebrae are more frequently affected. Low quality data do not allow safe conclusion to suggest the best treatment option.
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Affiliation(s)
- Nikolaos Patelis
- 3rd Department of Vascular Surgery, Athens Medical Center, Marousi, Greece
| | - Petroula Nana
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Konstantinos Spanos
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Panagiotis Tasoudis
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros Brotis
- Neurosurgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Theodosios Bisdas
- 3rd Department of Vascular Surgery, Athens Medical Center, Marousi, Greece
| | - George Kouvelos
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Abstract
PURPOSE OF REVIEW Cardiac involvement in patients with ankylosing spondylitis (AS) generally manifests itself as aortic insufficiency, aortitis, disturbance in cardiac conduction, and myocardial dysfunction. We have used a case-based approach to review the current state of the art knowledge regarding the diagnosis and management of aortic valve disease and aortitis in patients with AS. RECENT FINDINGS The risk for aortic valve disease and aortic valve replacement or repair is significantly higher than in people without AS, and this risk increases with age. Echocardiography, cardiac MRI, and CT can serve as effective tools for screening and follow-up. Surgical repair/replacement remains the mainstay of therapy for aortic insufficiency and aortic dilation, whereas transcatheter-based techniques may be favorable in the setting of aortic stenosis. Aortic valve and atrioventricular conduction abnormalities contribute to overall cardiovascular burden in AS. Optimal timing and therapeutic technique are dependent on assessment of overall risk and serial follow-up.
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Mielnik P, Hjelle AM, Nordeide JL. Coexistence of Takayasu’s arteritis and ankylosing spondylitis may not be accidental – Is there a need for a new subgroup in the spondyloarthritis family? Mod Rheumatol 2017; 28:313-318. [DOI: 10.1080/14397595.2017.1341592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Pawel Mielnik
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Anja Myhre Hjelle
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
| | - Jan Leidulv Nordeide
- Section for Rheumatology, Department for Neurology, Rheumatology and Physical Medicine, Helse Førde, Førde, Norway
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Shen YH, LeMaire SA. Molecular pathogenesis of genetic and sporadic aortic aneurysms and dissections. Curr Probl Surg 2017; 54:95-155. [PMID: 28521856 DOI: 10.1067/j.cpsurg.2017.01.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Ying H Shen
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX.
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX.
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Miller RJH, Moore R, Kim B, Mosher D, Alvarez N. Inflammatory aortic aneurysm in a young patient with ankylosing spondylitis. J Vasc Surg 2016; 66:600-604. [PMID: 27988155 DOI: 10.1016/j.jvs.2016.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/24/2016] [Indexed: 11/19/2022]
Abstract
Inflammatory conditions are a rare cause of aortic aneurysms, accounting for 3% to 10% of cases. Patients with ankylosing spondylitis uncommonly present with ascending aortic aneurysms related to long-standing, aggressive disease. We review the case of a young man with ankylosing spondylitis exhibiting complex inflammatory aortic aneurysms atypically involving the abdominal and descending thoracic aorta, as well as ectasia of medium-sized visceral vessels. Inflammatory aneurysms require a multidisciplinary approach incorporating diagnostic modalities to confirm etiology, targeted immunosuppressive therapy to control disease activity, and aneurysm repair. Evidence suggests that endovascular approaches should be considered first-line therapy for patients requiring reconstruction when anatomy is appropriate.
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Affiliation(s)
- Robert J H Miller
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Randy Moore
- Department of Vascular Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Byung Kim
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Mosher
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nanette Alvarez
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
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Shovman O, Tiosano S, Comaneshter D, Cohen AD, Amital H, Sherf M. Aortic aneurysm associated with rheumatoid arthritis: a population-based cross-sectional study. Clin Rheumatol 2016; 35:2657-2661. [PMID: 27502778 DOI: 10.1007/s10067-016-3372-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/16/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022]
Abstract
There is substantial evidence that aortic aneurysm (AA) may be a manifestation of several systemic rheumatic disorders. However, only several studies have assessed the association between rheumatoid arthritis (RA) and AA. The aim of this study was to evaluate the incidence of AA in RA patients in a case-control study. A retrospective case-control study was performed utilizing the database of Clalit Health Services (CHS), a large healthcare provider organization in Israel. Data available from the CHS database included age, sex, socioeconomic status (SES), and diagnoses of chronic diseases, including AA. Patients over the age of 20 years who were diagnosed with RA ("cases") were compared with a sample of age- and gender-matched enrollees without RA ("controls") regarding the prevalence of AA. Chi-square and t tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. The study included 11,782 RA patients and 57,973 age- and gender-matched controls. The proportion of AA was significantly higher in RA patients (0.72 %) compared to the control group 0.49 % (odds ratio (OR) 1.48, 95 %; confidence interval (CI) 1.15-1.88; p = 0.002). A multivariate analysis that evaluated covariates associated with AA revealed an independent association of AA and RA after adjustment for different factors including age, gender, SES, and smoking status (OR 1.406, 95 %; CI 1.094-1.789; p = 0.006). Our study has demonstrated that AA is more prevalent in patients with RA in comparison with general population. Future large randomized studies are important to identify cardiovascular- and disease-related risk factors for AA formation in RA patients.
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Affiliation(s)
- Ora Shovman
- Department of Medicine "B," Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, 5262100, Tel-Hashomer, Israel
| | - Shmuel Tiosano
- Department of Medicine "B," Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, 5262100, Tel-Hashomer, Israel
| | | | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine "B," Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, 5262100, Tel-Hashomer, Israel.
| | - Michael Sherf
- Central Management, Clalit Health Services, Tel Aviv, Israel
- Department Of Public Health, Faculty Of Health Sciences, Ben-Gurion University Of Negev, Beer Sheva, Israel
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Lassalle C, Lonchampt MF, Puechal X, Dernis E. Aortite thoraco-abdominale au cours d’une spondylarthrite ankylosante : un nouveau cas et revue de la littérature. ACTA ACUST UNITED AC 2011; 36:200-8. [DOI: 10.1016/j.jmv.2011.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
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Palazzi C, Salvarani C, D'Angelo S, Olivieri I. Aortitis and periaortitis in ankylosing spondylitis. Joint Bone Spine 2010; 78:451-5. [PMID: 21185758 DOI: 10.1016/j.jbspin.2010.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 11/05/2010] [Indexed: 12/17/2022]
Abstract
Aortic involvement is a potential life-threatening complication of ankylosing spondylitis, usually occurring late in the course of this frequent disease. Inflammatory lesions evolving to fibrosis are primarily localized in the aortic root causing regurgitation, but this process can extend into the left atrium (subaortic bump) involving the mitral valve and the heart conduction system. First, second and third degree atrioventricular blocks are the most common conduction alterations described and they can be temporary. Chronic periaortitis has been described in ankylosing spondylitis patients. This disease is characterized by inflammation evolving to fibrosis and it is localized in the periaortic and peri-iliac retroperitoneum. It causes compressive effects on ureters and venous, arterial and lymphatic vessels. Its treatment employs endoscopic and/or surgical procedures and administration of corticosteroids, even in association with immunosuppressive agents. Both aortitis (with conduction system alterations) and periaortitis should be kept in mind by the physicians because they can significantly influence the prognosis of ankylosing spondylitis patients and they can need a rapid treatment.
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Affiliation(s)
- Carlo Palazzi
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy.
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12
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Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Chalumeau NC, Boutin DLTH, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 2010; 89:1-17. [PMID: 20075700 DOI: 10.1097/md.0b013e3181cba0a3] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We conducted a single-center retrospective study to compare the characteristics of Takayasu arteritis (TA) among white, North African, and black patients in a French tertiary care center (Hospital Pitié-Salpêtrière, Paris). Eighty-two patients were studied (82.9% female) during a median follow-up of 5.1 years (range, 1 mo to 30 yr). Among these 82 patients, 39 (47.6%) were white, 20 (24.4%) were North African, and 20 (24.4%) were black patients. Median age at diagnosis was 39.3 years (range, 14-70 yr) in white patients vs. 28.4 years (range, 12-54 yr) in North African (p = 0.02), and 28.0 years (range, 13-60 yr) in black patients (p = 0.08). Patients aged >40 years at TA onset were more frequently white than non-white (40.0% vs. 18.6%, p = 0.03). North African patients had more frequent occurrence of ischemic stroke (p = 0.03) and poorer survival (p = 0.01) than white patients. Type V of the Hata classification was the most frequent type among white (38.5%), North African (65.0%), and black patients (40.0%). Corticosteroids were used in 96.1% of patients. Fifty-three percent of white and North African patients, and 44% of black patients required a second line of immunosuppressive treatment (p = 0.60). Vascular surgical procedures were respectively performed in 46.1%, 50.0%, and 55.0% of white, North African, and black patients, p = 0.81. The 5-year and 10-year survival rates were 100% and 95.0%, respectively, in white patients; 67.4% at both 5 years and 10 years in North African patients; and 100% at both 5 years and 10 years in black patients. This study is one of the first direct comparisons of TA profiles among patients of distinct ethnic backgrounds. Our data support the idea that late-onset TA or an overlap between TA and large-vessel giant cell arteritis may be observed in white patients. North African patients have a higher occurrence of ischemic stroke and poorer survival than white patients.
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Affiliation(s)
- Laurent Arnaud
- From Service de Médecine Interne (LA, JH, NL, NCC, DB, P Cacoub, JCP, ZA), Service de Radiologie (DT, P Cluzel), Service de Santé Publique (LG), and Service de Chirurgie Vasculaire (FK, EK); and Hôpital Pitié-Salpêtrière, AP-HP, Université Paris 6, Paris, France
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Abstract
Cardiovascular involvement is one of the extra-articular manifestations of ankylosing spondylitis. Of these, aortic disease and aortic regurgitation are the most commonly associated cardiovascular disorders. Since 2005, three male patients with ankylosing spondylitis were referred to The Chaim Sheba Medical Center for surgical treatment of cardiovascular associations. The diagnosis of ankylosing spondylitis was evidenced by radiography and/or laboratory tests of C-reactive protein or HLA-B27. Apart from the usual cardiac manifestations including heart block and left ventricular hypertrophy, usual associated disorders such as aortic aneurysmal dilation, bicuspid aortic valve, aortic root dilation and myocardial infarction, and solely bicuspid aortic valve that developed in these patients warranted a surgical intervention. Aortic aneurysmal dilation is a recognized rare association with ankylosing spondylitis, and bicuspid aortic valve or coronary artery disease is only occasionally present. Decreased aortic elasticity with impaired endothelial function could be responsible for the development of the aortic complication in ankylosing spondylitis patients. The underlying mechanisms of these associations are discussed.
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Affiliation(s)
- Shi-Min Yuan
- *Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Schirmer M, Duftner C, Seiler R, Dejaco C, Fraedrich G. Abdominal aortic aneurysms: an underestimated type of immune-mediated large vessel arteritis? Curr Opin Rheumatol 2006; 18:48-53. [PMID: 16344619 DOI: 10.1097/01.bor.0000198001.35203.36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To review recent studies on the immune-mediated pathogenesis of abdominal aortic aneurysms, opening a wide field for possible new therapeutic approaches. RECENT FINDINGS Immune-mediated processes including involvement of neutrophils, interferon-gamma producing T cells and proinflammatory cytokines play an important role especially in the initiation of abdominal aortic aneurysm disease. C-reactive protein was associated with aneurysm size and is possibly produced by the aneurysmal tissue itself. From the clinical perspective, both inflammatory and noninflammatory abdominal aortic aneurysms are associated with various autoimmune diseases. Preliminary data of F-FDG positron emission tomography imaging of abdominal aortic aneurysms suggest focal uptake of F-FDG within the aneurysm wall in patients with either large, rapidly expanding or symptomatic aneurysms that are prone to rupture. Thus basic research findings and clinical research focusing on the underlying immune-mediated mechanisms of abdominal aortic aneurysms will likely pave the way for new medical therapies in the future. In animal models the effects of rapamycin as an immunosuppressive agent, modulation of estrogen receptors by tamoxifen as well as gene therapy using decoy oligonucleotides binding to the transcription factor ets has already proved helpful in decreasing aneurysm expansion rates. SUMMARY Pathophysiological, immunogenetical and interventional studies support the concept of abdominal aortic aneurysm as an immune-mediated process, which will help to identify more laboratory and imaging signs of development in the future. Further research will now assess the possible benefit of antiinflammatory therapeutic approaches, especially in patients with small abdominal aortic aneurysms.
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Affiliation(s)
- Michael Schirmer
- Department of Internal Medicine, Innsbruck Medical University, Austria, Innsbruck Medical University, Austria.
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Afeltra A, Gentilucci UV, Rabitti C, Amoroso A, Caricato M, Vadacca M, Valeri S, Zardi EM, Coppola R, Picardi A. Retroperitoneal fibrosis and ankylosing spondylitis: which links? Semin Arthritis Rheum 2005; 35:43-8. [PMID: 16084223 DOI: 10.1016/j.semarthrit.2005.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report a case of retroperitoneal fibrosis (RPF) in a patient with ankylosing spondylitis (AS) and to review the medical literature for similar cases to detect possible links between the 2 diseases. METHODS The presentation, clinical course, diagnostic work-up, and treatment of our patient are described, and the English and French medical literature from 1960 to 2000 is reviewed using a MEDLINE search for cases with coexisting RPF and spondyloarthritis. RESULTS Our patient with AS had RPF, which mimicked rectal cancer with retroperitoneal and vertebral metastases. Special attention is paid to the unusual clinical presentation, the multistep diagnostic process, and the therapeutic strategy which was both radiologically and histologically successful. Literature review revealed 18 cases of concomitant RPF and spondyloarthritis, mainly AS. Patients were more frequently male (M/F, 3/1) and developed spondyloarthritis several years before RPF. CONCLUSIONS RPF may result from a local immune response to products of aortic atheromatous plaques, with subsequent periaortic deposition of fibrous tissue. However, the clinical features and the frequent association with other fibrosing disorders suggest that RPF is a systemic inflammatory condition. The role of AS-associated aortitis in the development of RPF warrants consideration.
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Affiliation(s)
- Antonella Afeltra
- Department of Internal Medicine, Immunology, and Rheumatology, University Campus Bio-Medico, 00155 Rome, Italy.
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Bono CM, Min W. Avoiding complications in patients with ankylosing spondylitis undergoing spine surgery. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/01.bco.0000160711.77444.df] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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