Ankylosing spondylitis presenting as spondylodiscitis

Summary Spondylopathy is a relatively common finding in advanced ankylosing spondylitis (AS). However noninfectious spondylodiscitis as an early manifestation of AS seems to be exceptional. In this article, we present such a case in an adolescent.     

Ankylosing spondylitis associated with osteoporosis and vertebral deformity

Summary We report a 56-year old man with ankylosing spondylitis associated with osteoporosis and vertebral deformity.     

Ankylosing spondylitis presenting with macrophage activation syndrome

Macrophage activation syndrome (MAS), which can also be considered as reactive hemophagocytic syndrome (HPS), is a rare and potentially fatal complication of rheumatic diseases. We describe a 42-year-old woman in whom MAS developed as a complication of ankylosing spondylitis (AS). She suffered from fever and low back pain before admission. Laboratory findings were pancytopenia, abnormal liver enzymes, increased ferritin levels, and positive for B27. Hyperplasia of hemophagocytic macrophages was confirmed in her bone marrow. High-dose steroids therapy resulted in clinical and laboratory improvements. In this patient, there was no possible causative factor of HPS (such as viral infection, lymphoma, and systemic lupus erythematosus) except the presence of AS. There have been no previously reported cases describing the relationship between AS and HPS. This case indicates that attention should be given to the possibility that certain patients with AS-associated cytopenia may display accompanying intramedullary hemophagocytic phenomena.     

Ankylosing spondylitis and infections of the female urogenital tract

Thirty-two female patients with confirmed ankylosing spondylitis (AS) and 33 women of similar age with pure ileitis terminalis Crohn were examined for genitourinary infection. Urethral syndrome was found in 15 out of 32 patients with AS: 11 of them had urethritis and 4 urethritis associated with vaginitis. Five women of the control group suffered from urethritis. In all cases with genitourinary infection, Chlamydia trachomatis was isolated. By comparing the AS-patients (urogenital infection group and the non-infected group) with regard to other present clinical parameters, it was found, as expected, that the erythrocyte sedimentation rate in the 1st hour was significantly higher in the infected group. In addition, the infected patients had a significantly higher incidence of enthesopathy, involvement of the spinal column, and higher C-reactive protein values (CRP ≥ 5 mg/l). A family history of AS was equally present. Other clinical parameters, such as inflammatory involvement of the joints and HLA-B27 correlation, did not differ significantly between infected and non-infected patients. Received: 22 July 1997 / Accepted 9 January 1998     

Ankylosing spondylitis in two Zaïrian brothers

Summary Ankylosing spondylitis has never been described in Zaïre and is considered to be rare in black African populations. We report two cases observed in the University Hospital of Kinshasa. The two patients are brothers. The diagnosis is based on anaemnestic, clinical and radiological findings. We therefore demonstrate the existence of this disease in Zaïre and presume that other similar cases may be diagnosed.     

Ankylosing spondylitis and bowel disease

Clinical studies indicate an important role for bowel inflammation in ankylosing spondylitis and other spondyloarthropathies whereby two different aspects have to be considered. First, the gut inflammation is clinically and histologically closely related to Crohn's disease. Recent data on subclinical immune alterations confirm this relationship and suggest that spondyloarthropathy is a unique human model for studying early Crohn's disease. Second, bowel and peripheral joint inflammation are clinically, histologically and pathogenetically linked. The most important clinical implication of these observations is that targeted therapies for Crohn's disease could also be effective for intestinal as well as extra-intestinal disease manifestations in spondyloarthropathy, as evidenced by the recent studies on TNF-alpha blockade. Unravelling the gut-synovium axis in spondyloarthopathy could also contribute to the identification of new therapeutic targets. Finally, assessment of subclinical gut inflammation by histology, serology and genetics could contribute to the stratification of individual patients in subgroups with an optimal response to specific therapeutic interventions.     

Ankylosing spondylitis and bowel disease

Between 5 and 10% of cases of ankylosing spondylitis (AS) are associated with inflammatory bowel disease (IBD), either Crohn's disease or ulcerative colitis. A much larger percentage of AS patients have subclinical gut inflammation manifested either by endoscopic findings or by histology. The association with HLA-B27 is less strong in IBD-associated AS than in idiopathic AS, and there is evidence for an association between gut inflammation in AS with the Crohn's-disease-related CARD15 mutations. Despite the different genetics, the immunopathology suggests common inflammatory pathways in gut and joint inflammation in AS, and in gut inflammation in AS and IBD. Although this observation is of interest to unravel the pathophysiology of the disease, systematic screening of AS patients by ileocolonoscopy is not indicated in the absence of gut symptomatology as only a small proportion of AS patients with subclinical gut inflammation will develop overt IBD over time. Treatment of AS associated with IBD with non-steroidal anti-inflammatory drugs (NSAIDs) is problematic because of concerns of potential re-activation of IBD by NSAIDs. Major advances have been made in recent years with the establishment of anti-tumour necrosis factor (TNF) therapy in AS, the other spondyloarthritides and IBD. Anti-TNF agents are of particular relevance to AS patients with concomitant IBD who are at risk of exacerbation of the underlying bowel disease when treated with NSAIDs. In IBD, infliximab, unlike etanercept, is effective in treating clinical symptoms, inducing and maintaining remission, and mucosal healing. Adalimumab appears to be effective in treating both AS and IBD; however, official approval is pending. Currently, infliximab is the drug of choice for the treatment of patients with active AS associated with IBD.     

Coexisting ankylosing spondylitis and gouty arthritis

The aim of this study was to investigate the clinical characteristics of patients with coexisting ankylosing spondylitis (AS) and gout. Between July 1987, and October 2004, sixty-five patients with coexisting AS and gout were enrolled. The clinical manifestations of both AS and gout in these patients were studied. Of the 65 patients included in the study, 61 were men and four were women (men-to-women ratio, 15.3:1). Sixty-three subjects were Han Chinese, and two were Atayal Aborigines. Mean ages at onset of AS and gout were 29.3 ± 15.6 years (range 7–63) and 42.2 ± 13.2 years (range 20–74), respectively. Fifty-six patients developed gout after (15.5 ± 11.2 years; range, 1–51 years) onset of AS; nine patients developed gout before (average, 3.4 ± 2.2 years; range. 1–7 years) onset of AS. Forty-four (67.7%) patients had chronic peripheral arthritis and all 65 (100%) patients had acute peripheral arthritis. Thirty-three (50.8%) cases had heel pain (enthesopathy), including 22 (33.9%) with chronic heel pain, seven (10.8%) with acute heel pain, and four (6.2%) with concurrent acute and chronic heel pain. Sixty-one (93.9%) subjects were HLA-B27 antigen positive. Medical conditions potentially associated with hyperuricemia or gout were urolithiasis (n = 17), hypertension (n = 21), diabetes mellitus (n = 8), hyperlipidemia (n = 34), congestive heart failure (n = 6), coronary heart disease (n = 5), and stroke (n = 3). The following drugs were prescribed: diuretics (n = 7), low-dose aspirin (n = 4), antituberculous drugs (n = 1), and sulphasalazine (n = 34). Six (6.2%) patients had iatrogenic Cushing syndrome with adrenal insufficiency. Patients with coexisting AS and gout are not rare. Distinguishing between peripheral arthritis or enthesopathies of AS and gout is essential, especially when the course of AS arthritis becomes acute or the course of gout becomes chronic.     

Late-onset peripheral joint disease in ankylosing spondylitis

We reviewed the records of 150 patients with definite ankylosing spondylitis who had significant peripheral arthritis and were seronegative and found 7 patients who had the onset of peripheral arthritis after their spinal disease became inactive. This late-onset peripheral arthritis may lead to significant joint deformity, and aggressive therapy may be warranted.     

Ankylosing spondylitis in a patient with Turner syndrome: a case report

Turner’s syndrome (TS) is a chromosomal disorder where phenotypic females have either a missing chromosome (45 X0) or a structural aberration of one of the chromosomes. It is possible for TS to accompany such autoimmune diseases as thyroid diseases, inflammatory intestinal diseases, diabetes mellitus, psoriatic arthritis and juvenile rheumatoid arthritis. Herein, we present an unusual case with Ankylosing spondylitis (AS) and autoimmune thyroiditis associated with TS. We suggest that the possibility that TS patients may also develop such other diseases as AS apart from the already known accompanying autoimmune diseases should not be ruled out when monitoring TS patients.     

Ankylosing spondylitis associated with vitiligo: a case report

 Vitiligo is a very common disease and is suspected to be autoimmune in its pathogenesis. Many autoimmune complications, such as Hashimoto's thyroiditis, are reportedly associated with vitiligo. The pathogenesis of ankylosing spondylitis (AS) is also suspected to be autoimmune, triggered by some infection. We report a 56-year-old man with concurrent vitiligo and AS, and suggest that both diseases could have a common autoimmune background. Received: September 5, 2001 / Accepted: April 4, 2002 Correspondence to:M. Mukai     

Coexisting ankylosing spondylitis and Paget's disease

Summary The case of a 59-year-old man with definite HLA B27 negative ankylosing spondylitis (AS) and Paget's disease involving the skull, the right side of the pelvis and the proximal femur is reported. Fifteen cases with this coexistence have previously been described. Some of these, however, are patients with Paget's disease mimicking AS. It is emphasized again that attention must be paid to diagnosing AS in patients suffering from Paget's disease.     

Ankylosing spondylitis lung disease and Mycobacterium scrofulaceum

The development of apical pulmonary fibrosis and bullous disease is a rare but well recognized extra-articular manifestation of ankylosing spondylitis (AS). The fibrobullous disease is usually asymptomatic and diagnosed at an incidental radiological examination. When symptoms do develop, they are usually due to superimposed colonization or infection by bacteria, fungi or mycobacteria. Only six cases of non-tuberculous mycobacterial superinfection in AS have been reported. We report a patient with AS and progressive apical fibrobullous disease in whom Mycobacterium scrofulaceum was repeatedly cultured over a 12-year period.     

Defining disease status in ankylosing spondylitis: validation and cross-cultural adaptation of the Arabic Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Global score (BASG)

The Bath Ankylosing Spondylitis Functional Index (BASFI), disease activity index (BASDAI), and Global assessment (BASG) are the most commonly used instruments to assess patients suffering from ankylosing spondylitis (AS). The aim of this study was to translate, adapt, and validate these instruments into the Arabic language. Seventy-three AS patients were included in this study. One question in the BASFI questionnaire was changed to suit the Arabic culture. Also, the VAS in the questionnaires was transformed to numerical rating scales from 0 to 10. After modification, translation, and retranslation of the questionnaires, it was administered and tested for internal consistency, reliability, and construct validity. Magnetic resonance imaging (MRI) of the spine and sacroiliac joints was carried out for 69 patients; scores for disease activity and chronicity were also assessed. The adapted and translated questionnaires demonstrated acceptable comprehensibility scores with a mean of 9.3. Intraclass correlation coefficients for reliability and internal consistency was 0.973 for BASG, whereas standardized alpha ranged between 0.807 and 0.976. The modified item 9 in the BASFI demonstrated a good correlate to the principal component (0.883). When validated, all three questionnaires showed a significant correlation with enthesitis, BAS-radiology index, MRI imaging scores for activity and chronicity, C-reactive protein (CRP), and morning stiffness duration. The Arabic version of the BASFI, BASDAI, and BASG, showed adequate reliability and validity in patients with AS. The measurement properties were comparable to versions in other languages indicating that the questionnaires can be used for evaluation of AS Arabic-speaking patients. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Arthroplasty for temporomandibular joint ankylosis secondary to ankylosing spondylitis

Summary Although temporomandibular joint involvement is frequent in ankylosing spondylitis, ankylosis seldom ensues. A patient with a temporomandibular joint ankylosis secondary to ankylosing spondylitis is presented. Treatment consisted of an osteoarthrectomy, followed by a costochondral ribgraft. A follow-up period of 39 months showed a satisfactory result.     

Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait: a comparison between Arabs and South Asians

The objectives of this study were to describe and compare the clinical characteristics of ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA) in Middle East Arab (MEA) and South Asian (SA) patients diagnosed in our unit. Fifty-eight consecutive patients diagnosed with SpA were studied after classifying them into MEA and SA. They were further classified as per disease diagnosis. Excluding three patients with miscellaneous ethnicity, there were 29 MEA and 26 SA patients. Seventy-two percent of MEA patients were males (vs 92% of SA patients). Of the 29 patients with MEA ethnicity, 17 had AS and 9 had USpA. Of the 26 patients with SA ethnicity, 10 had AS and 14 had USpA. Fifty-nine percent of MEA patients had AS (vs 39% of SA patients). Mean age at onset in AS patients was similar in the two ethnic groups. However, in patients with USpA, mean age at onset was somewhat lower at 21.8 years in the MEA group compared with 29.4 years in the SA group. Family history in first-degree relatives was significantly more common in MEA patients. Weight loss, inflammatory spinal pain, gluteal pain, and enthesopathy were equally common in both ethnic groups. Knee, ankle, and metatarsophalangeal joint involvement was less common in MEA patients. There were no significant differences in the occurrence of syndesmophytes, bamboo spine, and sacroiliitis in the two ethnic groups. HLA-B27 positivity rates in MEA patients were 87% for AS and 67% for USpA compared to 75 and 71%, respectively, in SA patients. It is concluded that some significant new findings have arisen from this study: the majority of MEA patients presented with AS, whereas the majority of SA patients had a picture of USpA. Family history was more common in MEA patients. Peripheral arthritis was less common in MEA patients. Worldwide, this is the first study to show that there are significant differences in the clinical expression of the various SpA in MEA patients compared to SA patients.     

Ankylosing spondylitis and pregnancy

In contrast to what is known for RA, pregnancy does not improve the symptoms of AS. The majority of women with AS has unchanged or temporarily aggravated disease activity during pregnancy. AS associated with other inflammatory states like psoriasis, IBS, or peripheral small joint arthritis, may benefit from pregnancy. Women with AS can expect to have the same rate of fertility, course of pregnancy, and normal delivery as the healthy female population. In general, female AS patients have healthy babies. However, the chance for their offspring to develop AS later in life is slightly increased.     

Ankylosing spondylitis and pregnancy

The pregnancy-induced remission typical of RA does not seem to occur in pregnant women with AS. The mechanisms for this difference are not understood, but appear to be related to different pathogenetic mechanisms operating in the two diseases. The vast majority of women with ankylosing spondylitis can expect to have the same rate of fertility, course of pregnancy and birth, and to give birth to normal healthy babies to the same extent as the normal female population. The chance for the offspring to contract AS later in life is somewhat increased.     

Ankylosing spondylitis and osteoporosis

PURPOSE: Ankylosing Spondylitis (AS) is an inflammatory rheumatism characterized by its disease course with flares leading to progressive ankylosis of the spine related to paravertebral ligamentous and discal structures ossification. AS patients suffer significantly more vertebral fractures than control groups. These fractures could affect cervical spine. They are due to either ankylosis-related flawed spine compliance or AS-induced osteoporosis. CURRENT KNOWLEDGE AND KEY POINTS: The physiopathology of this osteoporosis is multi-factorial, but essentially linked to AS-related inflammatory phenomenons. It is marked by reduced bone density (at lumbar spine and femoral neck), increased bone turnover (with increased urinary C-telopeptide cross-linked collagen type 1), but without any significant change in phosphocalcic blood parameters. Histological features are depressed bone formation, with either maintained or increased resorption. FUTURE PROSPECTS: The screening of this osteoporosis is based upon investigating people at risk (progressive inflammatory AS) using dual-energy x-ray absorptiometry and biochemical markers of bone turnover. Treatment is based upon a modulation of both inflammatory phenomenons and bone remodelling using bisphosphonates and anti-TNF alpha.