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Conduction disturbances are a well recognised extra-articular manifestation of ankylosing spondylitis and other spondyloarthropathies (SpA),1,2 disorders which are strongly associated with the HLA-B27 gene. Some, though not all studies, suggest an association between the presence of SpA and/or HLA-B27 and the occurrence of cardiac conduction disorders.3–7 This study aimed at determining the prevalence of SpA in a group of patients with a permanent pacemaker, and discovering whether these patients were more likely to be HLA-B27 positive than a group of controls.
Seventy six men and 51 women (mean age 73 years) with a permanent pacemaker who attended the cardiology department at the Hospital of Angra do Heroísmo (Terceira island, Azores) were assessed clinically for the presence of spondyloarthritis. All had pelvic radiographs performed and blood taken for HLA-B27 typing (polymerase chain reaction with sequence-specific primers).8 Pelvic radiographs were assessed by two qualified observers (JBA and CL) and, if sacroiliitis was suspected a computed tomographic scan of the sacroiliac joint was performed. SpA was diagnosed according to the European Spondylarthropathy Study Group (ESSG) criteria.9 Fifty men and 80 women (mean age 53 years) recruited from a population based register for participation in a screening survey of vertebral osteoporosis acted as a control group. These subjects had blood taken for HLA-B27.
Eighty one of the patients had evidence of atrioventricular conduction disturbances and the remaining patients had a pacemaker implanted for other reasons (auricular fibrillation/flutter, sick sinus disease, congenital diseases). Two patients with pacemaker had bilateral sacroiliitis; one a 56 year old man had had surgery for aortic insufficiency four years previously and had complete atrioventricular block. He was HLA-B7 positive, but had no history of inflammatory back pain or spondylitis on x ray examination. The other, a 72 year old man was HLA-B27 positive, though did have inflammatory back pain and severe spondylitis. The underlying cardiac abnormality was mobitz type 2 atrioventricular block. Based on the ESSG criteria the prevalence of SpA was 0.8%. HLA-B27 was present in six (5%) patients with a permanent pacemaker and nine (7%) of the control group (χ2=0.24; p=0.63).
In summary, in this observational study patients with a permanent pacemaker were no more likely to be HLA-B27 positive than a group of population controls.
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