Aneurysmal dilatation of ascending aorta and aortic insufficiency in juvenile spondyloarthropathy

Cardiovascular Involvement of Ankylosing Spondylitis: Report of Three Cases

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.

Cardiac arrhythmias and conduction disturbances in patients with ankylosing spondylitis

Conduction disturbances, aortic incompetence, and myocardial fibrosis are known complications in adult patients with ankylosing spondylitis (AS). Its incidence has been reported to be 10% to 30%; however, less attention has been paid to all cardiac arrhythmias. The aim of this study was to evaluate arrhythmias and conduction disturbances in patients with AS using electrocardiograms and Holter monitoring (including heart rate variability analysis) and to estimate its relationships with age, gender, clinical features, and duration of AS. Thirty-one patients with AS (20 to 69 years old, mean 50 +/- 14) and 22 healthy volunteers (26 to 69 years old, mean 49 +/- 13) underwent rheumatologic and cardiologic evaluations. Ventricular extrasystoles were present in 55% of AS patients and in 28% of controls. Supraventricular extrasystoles were present in 94% of AS patients and 100% of controls. The frequency of ventricular extrasystoles was found to be higher in the AS patients than in the control subjects. Significant differences were found in heart rate variability analyses: ultra low-frequency power and root mean square recessive difference (r-MSSD) were lower in the AS group. When the AS group was divided into subgroups (stages 3 and 4), significant differences were found between control subjects and stage 3 patients in PR interval, heart rate (HR), T-wave duration, ultra low frequency, and r-MSSD and between controls and stage 4 patients in HR, T-wave duration, and r-MSSD. QTc and QTd were not significantly different in groups and subgroups and were not correlated with any other clinical or electrocardiographic parameter. Cardiac arrhythmias were more frequent in patients with AS than in the healthy population. Simple electrocardiograms and Holter parameters do not correlate with the incidence of VESs, age, gender, clinical features, and duration of AS.

Juvenile onset spondyloarthropathies

Refinement of criteria for classifying childhood rheumatic diseases has contributed to earlier, more complete, and more precise diagnosis of children with spondyloarthropathies. Recent additions to the literature have contributed new international perspectives relating to the prevalence of juvenile spondyloarthropathies. Aspects of extra-articular features of juvenile spondyloarthropathies, including ocular, cardiac, and pulmonary disease have been considered in recent publications. The value of magnetic resonance imaging in identifying sacroiliitis in children and adolescents has been proposed. A study of cytokine profiles in chronic childhood arthritides could have both pathogenic and potential therapeutic implications. Factors influencing the course and prognosis of juvenile spondyloarthropathies have been presented in recent literature contributions.