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Demouveaux A, Delclaux M, Goudot A, Duponchelle E, Cortet B, Flipo RM, Letarouilly JG. Association of axial spondyloarthritis and IgA vasculitis: Report of two cases. Joint Bone Spine 2024; 91:105723. [PMID: 38582363 DOI: 10.1016/j.jbspin.2024.105723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Adèle Demouveaux
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | - Martin Delclaux
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | - Astrid Goudot
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | | | - Bernard Cortet
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | - René-Marc Flipo
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
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2
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Xing Y, Zhuang C, Yu Q, Liu C, Xu M, Zhao L, Kong X. Cutaneous leukocytoklastic vasculitis in a patient with ankylosing spondylitis: A case report. Heliyon 2024; 10:e28134. [PMID: 38524579 PMCID: PMC10958421 DOI: 10.1016/j.heliyon.2024.e28134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Extra-articular manifestations (EAMs) in ankylosing spondylitis (AS) are common and most extra-articular manifestations such as acute iritis and inflammatory bowel disease are positively correlated with disease activity of AS. Vasculitis is an extra-articular manifestation of AS. However cutaneous leukocytoclastic vasculitis (CLV) is uncommon in AS patients. In this article, we report a case of a 66-year-old female patient who has had AS for long time. Although the patient's articular manifestations were stable, the aortic aneurysm and CLV continued to occur sequentially. This article reminds clinicians that even AS patients with stable articular manifestations should be followed up regularly. All extra-articular manifestations of AS patients should be taken seriously and treated as soon as possible under the guidance of rheumatoid immunologists.
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Affiliation(s)
- Yida Xing
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Chengjun Zhuang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Dalian Medical University, China
| | - Qian Yu
- Wound Stoma Clinic, The Second Affiliated Hospital of Dalian Medical University, China
| | - Changyan Liu
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Mingxi Xu
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Lin Zhao
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Xiaodan Kong
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
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3
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Przygocka A, Berti GM, Campus A, Tondolo F, Vischini G, Fabbrizio B, La Manna G, Baraldi O. Rituximab as possible therapy in TNF inhibitor-induced IgA vasculitis with severe renal involvement. BMC Nephrol 2023; 24:381. [PMID: 38124070 PMCID: PMC10731765 DOI: 10.1186/s12882-023-03439-0] [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: 09/26/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND We observe the increasing use of tumor necrosis factor (TNF) inhibitors in patients affected by chronic inflammatory diseases. These drugs provide good control of symptoms, contributing to significant improvement in the quality of life in individuals with high disease burden. On the other hand, along with their wider use and longer follow-up periods the number of reports regarding their adverse effects is also increasing. The reported complications include drug-induced vasculitis with possible kidney involvement. In the literature we can distinguish more frequently described ANCA-associated vasculitis and more rarely occurring immunoglobulin A vasculitis. Although uncommon, such complications may present with potentially life-threatening vital organ dysfunction; therefore, adequate monitoring and effective therapy are necessary. CASE PRESENTATION We report two cases of TNF inhibitor-induced vasculitis with severe acute worsening of renal function and significant proteinuria. The first patient was receiving golimumab therapy for ankylosing spondylitis and the second patient was treated with adalimumab for psoriasis and psoriatic arthritis. In the second case dialysis treatment was necessary and the patient presented recurrence of vasculitis after rechallenge with adalimumab. Both patients underwent renal biopsy which showed findings compatible with drug-induced IgA vasculitis and both were treated successfully with corticosteroids and rituximab. CONCLUSIONS To the best of our knowledge this is the first report of rituximab use in drug-induced IgA vasculitis with renal involvement. Combination of corticosteroids and rituximab can be an effective therapy in case of vasculitis with kidney failure and a preferable option for selected patients with drug-induced IgA vasculitis compared to cyclophosphamide. More studies are necessary to establish suitable short- and long-term treatment. Given the rarity of this disorder, case reports and case series can provide practical guidance until additional studies become available.
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Affiliation(s)
- Agnieszka Przygocka
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Gian Marco Berti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Anita Campus
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Francesco Tondolo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Gisella Vischini
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Benedetta Fabbrizio
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Gaetano La Manna
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy, Via Giuseppe Massarenti 9, Bologna, Italy.
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, Bologna, Italy.
| | - Olga Baraldi
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
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4
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Wang R, Li Y, Liu Y, Hou X, Li C. Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) Syndrome with Henoch-Schönlein Purpura: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:1089-1094. [PMID: 37123621 PMCID: PMC10146069 DOI: 10.2147/ccid.s392909] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023]
Abstract
Introduction SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare disease clinically characterized by a wide range of cutaneous and osteoarticular manifestations, involving multiple system impairments. Vasculitis is a rare comorbidity of SAPHO. Henoch-Schönlein purpura (HSP) is a vasculitis involving the capillaries and arterioles mediated by IgA immune complex. No case report of SAPHO syndrome with HSP was ever found. Case Here we reported a case of SAPHO syndrome complicated with HSP and was successfully treated by methylprednisolone and tofacitinib. Discussion Although the treat-to-target management of HSP and the first-line clinical medication have given some advices on the treatment. A precise treatment was still needed based on the pathogenesis of the comorbidity. The mechanism of the co-occurrence includes innate immunity and adapted immunity. Considering the active inflammatory reaction and the rapid disease progression, methylprednisolone and tofacitinib were prescribed. Conclusion HSP is a new comorbidity of SAPHO. The spectrum of cutaneous small-vessel vasculitis in SAPHO syndrome was enriched. A new treatment approach for SAPHO with HSP was provided.
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Affiliation(s)
- Ruoyi Wang
- Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yingzi Li
- Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yuyue Liu
- Department of Pathology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xiujuan Hou
- Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Correspondence: Xiujuan Hou; Chen Li, Email ;
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, People’s Republic of China
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5
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Kamath S, Ahmed T, Rana F, Upadhyay AS. Rare case of ankylosing spondylitis complicated by IgA vasculitis. BMJ Case Rep 2022; 15:e252182. [PMID: 36423941 PMCID: PMC9693872 DOI: 10.1136/bcr-2022-252182] [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] [Indexed: 11/25/2022] Open
Abstract
Ankylosing spondylosis (AS) is characterised by bilateral sacroiliitis, asymmetric peripheral oligoarthritis, association with the human leucocyte antigen-B27, enthesitis and dactylitis. The association of IgA vasculitis with AS has been documented in few case reports. We present a rare case of a man in his 40s with AS, who presented with fever, bloody loose stools, abdominal pain, lower limb arthritis, palpable purpura over the lower limbs. He subsequently, also developed renal involvement in the form of proteinuria. His skin biopsy showed evidence of leucocytoclastic vasculitis, while renal biopsy showed focal proliferative, necrotising IgA glomerulonephritis. He was thus diagnosed to have Henoch Schonlein purpura with IgA nephropathy in the background of AS. He was treated with steroids and mycophenolate mofetil with resolution of his symptoms.
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Affiliation(s)
- Sangita Kamath
- Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Tauheed Ahmed
- Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Farah Rana
- Department of Pathology, Tata Main Hospital, Jamshedpur, Jharkhand, India
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Farisogullari B, Cuceoglu MK, Oral H, Yardimci GK, Bilginer Y, Ozen S, Karadag O. Biologics for immunoglobulin A vasculitis: targeting vasculitis or comorbid disease? Intern Emerg Med 2022; 17:1599-1608. [PMID: 35347546 DOI: 10.1007/s11739-022-02968-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Abstract
In this study, we aimed to evaluate the clinical features and treatments, including the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in a large cohort of pediatric and adult immunoglobulin A vasculitis (IgAV). Since data on the use of bDMARDs in IgAV are very limited, we collated the reasons for use of bDMARDs during the disease course. Patients who were enrolled in the Hacettepe University Vasculitis Research Centre (HUVAC) registry were included. In this prospective database dating from 2014, there were 436 IgAV patients classified as IgAV according to Ankara 2008 and/or American College of Rheumatology 1990 criteria. 88 adults and 330 pediatric IgAV patients were included as the main study group. Concomitant spondyloarthritis (SpA) was observed only in adult patients (10% vs 0% in children, p < 0.001). IgAV relapse was more common in adults than in children (p: 0.017). Adult patients were mostly treated with corticosteroid (p < 0.001) and conventional synthetic disease-modifying anti-rheumatic drug treatment (< 0.001), while more than half of the pediatric patients were followed up without immunosuppressive treatment. Ten (11%) adult patients used biologics. Among them, two patients used rituximab due to IgAV disease activity, three used infliximab due to SpA, three used etanercept due to SpA (one patient had a pediatric onset enthesitis-related arthritis), and two used anakinra due to recurrent familial Mediterranean fever attacks. This is the first study evaluating the use of all bDMARDs for any reason in the IgAV cohorts in the literature. None of the pediatric patients used biologics. Our data suggest biologics are mainly used for comorbid inflammatory diseases over refractory vasculitis in adult IgAV.
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Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Hakan Oral
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gozde Kubra Yardimci
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey.
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7
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Nossent J, Raymond W, Keen HI, Preen D, Inderjeeth C. Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study. Rheumatology (Oxford) 2021; 61:291-298. [PMID: 33779729 DOI: 10.1093/rheumatology/keab312] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With sparse data available, we investigated mortality and risk factors in adults with IgAV. METHODS Observational population-based cohort study using state-wide linked longitudinal health data for hospitalised adults with IgAV (n = 267) and matched comparators (n = 1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and hazard ratio (HR) for survival were assessed. RESULTS During 9.9 (±9.8) years lookback patients with IgAV accrued higher CCI scores (2.60 vs1.50 p < 0.001) and had higher risk of SI (OR 8.4, p < 0.001), not fully explained by CCI scores. During 19 years follow-up, the rate of death in Patients with IgAV (n = 137) was higher than in comparators (n = 397) (MRR 2.06, CI 1.70-2.50, p < 0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p < 0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7%) and twenty years (45.2% vs. 65.6%) (both p < 0.05). CCI (HR1.88, CI:1.25 - 2.73, p = 0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p = 0.03) and prior SI (HR 1.48, CI:1.01 - 2.16, p = 0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p = 0.02) was significantly more frequent in patients with IgAV. CONCLUSIONS Premorbid comorbidity accrual appears increased in hospitalized patients with IgAV and predicts premature death. As comorbidity does not fully explain the increased risk of premorbid infections or the increased mortality due to infections in IgAV, prospective studies are needed.
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Affiliation(s)
- Johannes Nossent
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, The University of Western Australia
| | - Warren Raymond
- Rheumatology Group, School of Medicine, The University of Western Australia
| | - Helen Isobel Keen
- Rheumatology Group, School of Medicine, The University of Western Australia.,Dept. Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David Preen
- School of Population and Global Health, The University of Western Australia
| | - Charles Inderjeeth
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, The University of Western Australia
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8
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Koca N, Ayar K, Can ME. Optical coherence tomography angiography findings in axial spondylarthritis. Rheumatol Int 2020; 40:901-913. [PMID: 32219479 DOI: 10.1007/s00296-020-04553-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study is to evaluate the density of retinal vascular structures and their relationship with disease duration and activity in patients with axial spondylarthritis (axSpA) using optical coherence tomography angiography (OCT-A). In this case-control study, 56 eyes of 29 axSpA patients and 61 eyes of 31 healthy controls (HCs) were evaluated using OCT-A. The capillary plexus density (CPD) of vessels in the parafovea and perifovea regions was evaluated from the superficial capillary plexus (SCP) and deep capillary plexus (DPC) flow areas. The CPD of vessels in the fundus was evaluated from the radial peripapillary capillary (RPC) flow area. Foveal avascular zone (FAZ) size was measured. In axSpA patients and HCs, the mean CPD (%) in the whole retina was 50.75 ± 2.59 and 52.43 ± 2.10 (p < 0.001) in SCP, 54.00 ± 5.83 and 58.37 ± 4.36 (p < 0.001) in DCP, and 50.13 ± 2.32 and 50.13 ± 2.26 (p = 0.984) in RPC flow areas, respectively, and the mean FAZ (mm) was 0.275 ± 0.10 and 0.294 ± 0.07 (p = 0.281), respectively. A significant negative correlation was detected between the CPD and disease duration in the parafovea (ρ: - 0.306, p = 0.022), parafovea superior-hemi (ρ = - 0299, p = 0.025), parafovea inferior-hemi (ρ = - 0.270, p = 0.044), parafovea temporal (ρ = - 0.349, p = 0.008) and parafovea nasal regions (ρ = - 0.356, p = 0.007) in the DCP flow area. CPD was found to be lower in the macula, while similar in the fundus region in axSpA patients compared to HCs. The decrease in CPD was correlated with disease duration, but not with disease activity in axSpA. Small vessel structures may be affected in axSpA. OCT-A may be used to detect subclinical vasculitis in axSpA patients.
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Affiliation(s)
- Nizameddin Koca
- Department of Internal Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Koray Ayar
- Department of Internal Medicine, Division of Rheumatology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa Sehir Training and Research Hospital, Bursa, Turkey
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John KJ, Sadiq M, Thomas M, Turaka VP. Henoch-Schonlein purpura associated with HLA-B27 positive axial spondyloarthritis in a young man. BMJ Case Rep 2019; 12:12/5/e228881. [PMID: 31129640 DOI: 10.1136/bcr-2018-228881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Axial spondyloarthropathies are characterised by bilateral sacroiliitis, asymmetric oligoarthritis, association with the human leucocyte antigen (HLA)-B27, enthesitis and dactylitis. Although IgA nephropathy has a well-documented association with seronegative spondyloarthropathies, the association with Henoch-Schonlein purpura (HSP) has been documented only in few case reports. The present case is that of a 26-year-old man who presented with fever, lower limb arthritis, abdominal pain, palpable purpura over the buttocks and lower limbs, and clinical features of sacroiliitis. His blood tests showed elevated inflammatory markers and rheumatoid factor was negative. CT scan of the sacroiliac joints confirmed sacroiliitis. Skin biopsy revealed neutrophilic small vessel vasculitis. HLA-B27 was positive in blood. A diagnosis of HSP with HLA-B27 positive axial spondyloarthritis was made. HSP can be associated with HLA-B27 positive axial spondyloarthritis and has to be considered while evaluating for causes of cutaneous small vessel vasculitis in such patients.
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Affiliation(s)
- Kevin John John
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mohammad Sadiq
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vijay Prakash Turaka
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Piubelli MLM, Felipe-Silva A, Kanegae MY, Ferraz de Campos FP. Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis. AUTOPSY AND CASE REPORTS 2019; 9:e2018070. [PMID: 30963052 PMCID: PMC6433139 DOI: 10.4322/acr.2018.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/24/2018] [Indexed: 12/15/2022] Open
Abstract
Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.
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Affiliation(s)
| | - Aloisio Felipe-Silva
- Universidade de São Paulo (USP), Faculty of Medicine, Department of Pathology. São Paulo, SP, Brazil.,Universidade de São Paulo (USP), Hospital Universitário, Anatomic Pathology Service. São Paulo, SP, Brazil
| | - Marcia Yoshie Kanegae
- Universidade de São Paulo (USP), Hospital Universitário, Internal Medicine Division. São Paulo, SP, Brazil
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Abstract
RATIONALE Cutaneous vasculitis is usually found in patients with rheumatoid arthritis (RA) as an extra-articular manifestation, but rare in patients with ankylosing spondylitis (AS). In this case, we describe an AS patient who developed large skin lesions, of which the histological findings were consistent with cutaneous vasculitis. PATIENT CONCERNS A 22-year-old male who was diagnosed as HLA-27 positive AS for 5 years. However, in the last year, he suffered a recurrent skin lesion in both lower extremities especially the dorsum of feet, accompanying with intense pruritus. DIAGNOSIS The originally diagnosis of the skin lessons was dermatitis, and then a skin biopsy pathology showed it was consistent with cutaneous vasculitis. INTERVENTION At first he was treated with gentamycin and ethacridine for nearly 2 weeks, the symptoms were relieved. But then he suffered severe cutaneous lesions with swell at the ulcerous margin in his dorsum of right foot. The patient was treated with dexamethasone 10 mg intravenous drip daily for 2 weeks, and followed by methylprednisolone 160 mg oral administration daily after discharge. The skin lesions were gradually healed in several months OUTCOMES:: This patient was followed up at 1-month, 5-month, and 10-month after discharged, the skin lessons was gradually healed and never occurred. LESSONS This case indicated that cutaneous vasculitis might be an extra-articular manifestation of AS in which IgA may plays a pathogenic part. All this may be associated with the damage of cytokines and autoantibodies to vascular endothelial wall caused by active inflammatory phase.
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Abstract
Leucocytoclastic vasculitis is a rare type of allergic disease caused by immune complexes. IgA nephropathy is a glomerulopathy characterized by recurrent episodes of gross haematuria or microscopic haematuria and IgA deposition in the glomerular mesangial region. IgA nephropathy complicating leucocytoclastic vasculitis is rare documented. We present a case of IgA nephropathy in a 47-year-old woman with leucocytoclastic vasculitis and discuss the clinical and pathological data, aiming to promote the diagnosis and treatment of this specific clinical manifestation.
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Affiliation(s)
- Lin-Yan Wei
- 1 Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,2 Department of Nephrology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Liu
- 2 Department of Nephrology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ya-Li Zhang
- 2 Department of Nephrology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guo-Liang Li
- 1 Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,2 Department of Nephrology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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13
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Taylan A, Yildiz Y, Sari I, Ozkok G. Vasculitis and long standing ankylosing spondylitis in a patient with familial Mediterranean fever. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:1009-11. [PMID: 25538787 PMCID: PMC4274560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/01/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022]
Abstract
Coexistence of familial Mediterranean fever (FMF) and other inflammatory disorders has been frequently reported, but no specific underlying factor has been identified. We report a patient with FMF who is presented with long-standing ankylosing spondylitis (AS) and cutaneous leukocytoklastic vasculitis (LV) of the lower limbs. It is the first report on combination of FMF with AS and LV. The Mediterranean Fever (MEFV) gene mutation of heterozygote (R202Q/R726A) and HLA-B27 are detected in this case, and are believed to form genetic susceptibility to LV.
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Affiliation(s)
- Ali Taylan
- Department of Rheumatology, Izmir Tepecik Training and Research Hospital, Izmir, Iran,Address for correspondence: Dr. Ali Taylan, Izmir Tepecik Teaching and Research Hospital, Rheumatology Section Yenisehir, Izmir, Turkey. E-mail:
| | - Yasar Yildiz
- Department of Internal Medicine, Izmir BozyakaTraining and Research Hospital, Izmir, Iran
| | - Ismail Sari
- Department of Internal Medicine, Izmir BozyakaTraining and Research Hospital, Izmir, Iran
| | - Guliz Ozkok
- Department of Pathology, Izmir BozyakaTraining and Research Hospital, Izmir, Iran
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Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton. Extra-articular manifestations are less common relative to other rheumatic diseases, and vasculitic complications typically involve the ascending aorta and aortic valve. The use of tumor necrosis factor inhibitors is efficacious in the treatment of patients with AS. Since their routine use, however, tumor necrosis factor inhibitors have been associated with the development of drug-induced complications including the induction of lupus and both cutaneous and systemic vasculitis. In this report, we describe a patient with severe longstanding AS, who developed Henoch-Schönlein purpura after commencing therapy with etanercept. Tumor necrosis factor inhibitor-induced Henoch-Schönlein purpura has been very rarely reported and has been mostly recognized in patients with rheumatoid arthritis.
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Ankylosing Spondylitis: Chinese Perspective, Clinical Phenotypes, and Associated Extra-articular Systemic Features. Curr Rheumatol Rep 2013; 15:344. [DOI: 10.1007/s11926-013-0344-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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16
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Pàmies A, Castro S, Poveda MJ, Fontova R. Leucocytoclastic vasculitis associated with golimumab. Rheumatology (Oxford) 2013; 52:1921-3. [DOI: 10.1093/rheumatology/ket125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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17
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Livedoid Vasculopathy With Underlying Subcutaneous Necrotizing Venulitis in an Asymptomatic Hepatitis B Virus Carrier: Is Livedoid Vasculopathy a True Nonvasculitic Disorder? Am J Dermatopathol 2009; 31:293-6. [DOI: 10.1097/dad.0b013e31819560aa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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de Moura CG, de Moura TGG, de Souza SP, Testagrossa L. Inflammatory Bowel Disease, Ankylosing Spondylitis, and IgA Nephropathy. J Clin Rheumatol 2006; 12:106-7. [PMID: 16601553 DOI: 10.1097/01.rhu.0000209619.00364.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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19
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Ben Taarit C, Ajlani H, Ben Moussa F, Ben Abdallah T, Ben Maïz H, Khedher A. Les manifestations rénales de la spondylarthrite ankylosante : à propos de 210 cas. Rev Med Interne 2005; 26:966-9. [PMID: 16236389 DOI: 10.1016/j.revmed.2005.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 07/20/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To define the epidemiology, clinical, biological and histological features of renal diseases in ankylosing spondylitis, ginving special attention to unusual forms. METHODS We retrospectively reviewed the medical record of 28 cases with renal involvement among 210 cases of ankylosing spondylitis seen over a 27 year period who met the Amor criteria. RESULTS Twenty-eight of 210 patients (13,3%) presented one or more signs of renal involvement: macroscopic hematuria (4 patients), microscopic hematuria (8 patients), proteinuria (15 patients), nephrotic syndrome (6 patients), decreased renal function (13 patients). Secondary renal amyloidosis and nephrolithiasis (8 patients) were the most common cause of renal involvement in ankylosing spondylitis followed by IgA nephropathy (3 patients). CONCLUSION The funding of renal abnormalities in 13,3% of our patients suggests that in this illness evidence of renal involvement should be actively investigated in ankylosing spondylitis.
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Affiliation(s)
- C Ben Taarit
- Unité de rhumatologie, laboratoire de pathologie rénale santé 02, service de médecine interne A, hôpital Charles-Nicolle, Tunis, Tunisie
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20
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Karter Y, Erzin Y, Bilici A, Kisacik B, Demirkesen C, Yaldiran A, Ozturk E. Cutaneous Vasculitis and Antiphospholipid Syndrome in a Patient With Ankylosing Spondylitis: How May They Be Related? J Clin Rheumatol 2002; 8:183-5. [PMID: 17041353 DOI: 10.1097/00124743-200206000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Abstract
Schönlein-Henoch syndrome is a form of systemic small-vessel vasculitis, characterised by vascular and/or mesangial immunoglobulin A1 deposits. The main clinical manifestations are vascular purpura, predominating on the lower limbs, and articular, gastrointestinal and renal symptoms. Pulmonary, cardiac, genital and neurological symptoms have also be observed. The syndrome usually affects children, whereas it is rare in adults. The frequency of renal involvement varies between individual studies (from 20 to 100%). Renal manifestations are usually mild and transient, although chronic nephropathies may occur. Overall, an estimated 2% of children with Schönlein-Henoch purpura progress to renal failure and up to 20% of children with nephritis treated in specialised centres require haemodialysis. The renal prognosis appears to be worse in adults. Aetiological investigations are required, as a triggering factor is found in approximately half the patients (e.g. viral, bacterial and parasitic infections, drugs, toxins, systemic diseases and cancer). Dapsone has beneficial effects on cutaneous, gastrointestinal and articular manifestations in adults, especially those with chronic forms. Corticosteroids may be useful for refractory abdominal pain. Methylprednisolone pulse therapy, immunosuppressive drugs (e.g. cyclophosphamide and azathioprine), plasma exchange and polyclonal immunoglobulin therapy are beneficial in very rare life-threatening forms of the disease and in rare instances where renal function is compromised.
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Affiliation(s)
- G Rostoker
- Service de Néphrologie et de Dialyse, Centre Hospitalier Privé Claude Galien, Quincy Sous Senart, France
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22
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Montenegro V, Monteiro RC. Elevation of serum IgA in spondyloarthropathies and IgA nephropathy and its pathogenic role. Curr Opin Rheumatol 1999; 11:265-72. [PMID: 10411380 DOI: 10.1097/00002281-199907000-00007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ankylosing spondylitis and IgA nephropathy share some immunologic features, eg, elevated serum IgA and IgA-immune complex levels. These entities are frequently found as being associated. IgA and IgA immune complex catabolism involves asialoglycoprotein receptors and specific IgA Fc receptors (FcalphaR or CD89) on tissue and blood cells. Recent studies revealed impaired CD89 expression in both diseases. These abnormalities, which are associated with receptor saturation, might generate the increase in serum IgA and IgA immune complex levels by either altered recycling or failure of degradation. This article reviews the literature on IgA abnormalities and discusses the potential role of FcalphaR in IgA nephropathy and AS and the consequences of its similar defect in the two diseases.
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Affiliation(s)
- V Montenegro
- Division of Rheumatology, University of São Paulo, Brazil
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23
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Blanco R, Martínez-Taboada VM, Rodríguez-Valverde V, García-Fuentes M. Cutaneous vasculitis in children and adults. Associated diseases and etiologic factors in 303 patients. Medicine (Baltimore) 1998; 77:403-18. [PMID: 9854604 DOI: 10.1097/00005792-199811000-00007] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Cutaneous vasculitis (CV), a condition characterized by palpable purpura and nonspecific histopathologic findings, presents a diagnostic and therapeutic challenge because it may be a primary disorder or it may be a cutaneous manifestation of another entity, such as systemic necrotizing vasculitis, connective tissue disease, systemic bacterial infection, or malignancy. We studied 303 unselected patients (172 adults and 131 children) with CV to assess the disease associations and etiologic factors, to identify the frequency of primary and secondary CV in different age-groups, and to characterize features that help to distinguish between primary and secondary CV. Of the 131 children, 130 had primary CV: Henoch-Schönlein purpura (HSP) in 116 and hypersensitivity vasculitis (HV) in 14. In contrast, of the 172 adults, only 120 had primary CV: HSP in 39, HV in 70, and essential mixed cryoglobulinemia in 11. CV was a manifestation of systemic necrotizing vasculitis in 23 adults (polyarteritis nodosa in 17, Wegener granulomatosis in 4, and Churg-Strauss syndrome in 2). CV was secondary to other processes in 29 adults: in 20 patients CV was associated with connective tissue disease or another autoimmune or rheumatic disease, in 5 patients CV was a manifestation of severe bacterial infection, especially bacterial endocarditis (4 cases), and in the other 4 patients CV was the presenting symptom of an underlying malignancy. The patients for whom CV was a manifestation of systemic necrotizing vasculitis or secondary to a connective tissue disease, severe bacterial infection, or malignancy had clinical and laboratory data suggestive of the associated disorder. The clinical picture and outcome of primary CV in both children and adults were benign. By contrast, the prognosis of patients with CV in the context of systemic necrotizing vasculitis or secondary to other entities depended on the primary process. Given the different disease association in children and adults, we propose a simple diagnostic workup in children with CV. By contrast the diagnostic approach in adults with CV should be more cautious and the workup more extensive. The early differentiation between primary CV, secondary CV, and CV presenting as a symptom of systemic necrotizing vasculitis, especially in adults, is of paramount importance for an adequate diagnosis and appropriate treatment.
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Affiliation(s)
- R Blanco
- Service of Rheumatology, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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24
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Tani Y, Sato H, Tanaka N, Mori K, Doida Y, Hukuda S. Serum IgA1 and IgA2 subclass antibodies against collagens in patients with ankylosing spondylitis. Scand J Rheumatol 1997; 26:380-2. [PMID: 9385351 DOI: 10.3109/03009749709065703] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We measured IgA1 and IgA2 subclass antibody levels against human type I, II, III and IV collagens in patients with ankylosing spondylitis (AS) by enzyme linked immunosorbent assay (ELISA). Significant elevations of IgA1 antibodies against type II collagen (p < 0.01) and IgA2 antibodies against type I (p < 0.001), III (p < 0.001), and IV (p < 0.01) collagens were observed in AS patients compared with those of healthy controls. These findings suggest that serum IgA antibodies against type I, III and IV collagens were mainly produced in secretory lesions in AS patients.
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Affiliation(s)
- Y Tani
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
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25
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Boehni U, Christen B, Greminger P, Michel BA. Systemic vasculitis associated with seronegative spondylarthropathy (Reiter's syndrome). Clin Rheumatol 1997; 16:610-3. [PMID: 9456014 DOI: 10.1007/bf02247802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A first case of Reiter's syndrome developing a severe systemic necrotising vasculitis is reported. After a disease course with major complications, aggressive consistent immuno-suppressive treatment was successful.
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Affiliation(s)
- U Boehni
- Department of Rheumatology, University Hospital Zürich, Switzerland
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26
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Chen JY, Ho HH, Wu YJ, Luo SF. Coexistence of spinal arteriovenous malformation and ankylosing spondylitis--are they related? Clin Rheumatol 1994; 13:533-6. [PMID: 7835025 DOI: 10.1007/bf02242959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 50-year-old man with long standing ankylosing spondylitis developed cauda equina syndrome, which was found to be coexistent with a spinal arterio-venous malformation. Paraplegia ensured following an acute exacerbation of back pain along with an attack of uveitis. Vasculitis changes were found on resected abnormal vessels.
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Affiliation(s)
- J Y Chen
- Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital
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27
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28
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Wendling D, Risold JC. [Nailfold capillaroscopy and ankylosing spondylarthritis: incidence of anomalies, but absence of diagnostic and prognostic value]. Rev Med Interne 1994; 15:448-51. [PMID: 7938955 DOI: 10.1016/s0248-8663(05)81468-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Vascular involvement is seldom reported in ankylosing spondylitis (AS). In this study, microcirculation was evaluated by nailfold capillaroscopy in 32 defined AS patients compared to a control group (C) of 14 sciatica. Capillary findings were divided into five groups: normal, minor dystrophies, edema, microangiopathy, stagnation. Capillaroscopic abnormalities were more frequent in SA as compared to C, for edema (40% vs 7%) and microangiopathy (15% vs 0%). P = 0.01. There were neither clinical nor biological differences between AS patients with and without microangiopathy. Capillaroscopy abnormalities seem frequent in AS and may be secondary to an immune complex mechanism.
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Affiliation(s)
- D Wendling
- Service de rhumatologie, hôpital Jean-Minjoz, CHU, Besançon, France
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