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FRI0350 Large vessel vasculitis and sacroiliitis: coincidence or associated diseases?
  1. D. Ernst1,
  2. N. Baerlecken1,
  3. R. E. Schmidt1,
  4. T. Witte1
  1. 1Klinik Für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Germany

Abstract

Background Coexisting large vessel vasculitis has previously been reported in cases of established spondyloarthritis (SpA) (1-3). The prevalence of sacroiliitis or peripheral SpA among patients with large vessel vasculitis is however unknown. The aim of this retrospective study was to determine the prevalence of SpA among patients with new-diagnosed aortitis at our center.

Methods All patients admitted to our Institution with new-diagnosed aortitis between January 2011 and December 2012 were retrospectively reviewed. Suspected vasculitides were confirmed in 15 cases by either MRI of the thoracic aorta or FDG-PET/CT scans. All patients were subsequently assessed using a standardized questionnaire based on the Berlin Criteria (4) for clinical features suggesting inflammatory back pain. Existing MRI scans in these patients were reevaluated for coincidental evidence of sacroiliitis. Routine laboratory was reviewed and ferritin-antibodies (5) retrospectively measured.

Results Fifteen patients, aged between 50 and 84 years with new-diagnosed aortitis were identified. The diagnosis was confirmed by MRI in 10 patients and FDG-PET/CT in the remaining five. Within this group all patients fulfilled ACR criteria for polymyalgia rheumatica, 5 (33%) of whom also fulfilled ACR criteria for temporal arteritis. Four patients from the entire cohort fulfilled Berlin criteria for inflammatory back pain, of whom 3 exhibited sacroiliitis on MRI and were classified as non-radiographic axial SpA. A further aortitis patient, not exhibiting clinical features of inflammatory back pain was treated for coexisting psoriatic arthritis. This patient along with the 2 of 3 MRI positive sacroiliitis patients (3 of 4 patients with aortitis and SpA) demonstrated positive ferritin antibodies.

Conclusions Our results demonstrate further evidence for coexisting autoimmune conditions with particular reference to large-vessel vasculitides. The observed prevalence of axial or peripheral SpA in new-diagnosed aortitis of 4/15 (27%), is much higher than anticipated, given a reported prevalence of 0.5-1% in the general population. In vasculitis patients demonstrating persisting inflammatory back pain following steroid initiation, coexisting SpA should be considered. Furthermore we confirm the previous observation, that ferritin antibodies have a high prevalence in untreated patients with giant cell arteritis and polymyalgia rheumatica (5), with similar rates apparent in patients with aortitis and SpA.

References

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  2. Valvular and coronary heart disease in systemic inflammatory diseases: Systemic Disorders in heart disease. Roldan CA. Heart. 2008 Aug;94(8):1089-101

  3. Aortitis and periaortitis in ankylosing spondylitis. Palazzi C, Salvarani C, D’Angelo S, Olivieri I.; Joint Bone Spine. 2011 Oct;78(5):451-5

  4. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Rudwaleit M, Metter A, Listing J, Sieper J, Braun J. Arthritis Rheum. 2006 Feb;54(2):569-78.

  5. Association of ferritin autoantibodies with giant cell arteritis/polymyalgia rheumatica. Baerlecken NT, Linnemann A, Gross WL, Moosig F, Vazquez-Rodriguez TR, Gonzalez-Gay MA, Martin J, Kötter I et al. Ann Rheum Dis. 2012 Jun;71(6):943-7.

Disclosure of Interest: None Declared

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