Lassalle C, Lonchampt M-F, Puechal X, Dernis E
Service de Rhumatologie, Centre Hospitalier du Mans, 194, avenue Rubillard, 72000 Le Mans, France.
J Mal Vasc. 2011 Jun;36(3):200-8. doi: 10.1016/j.jmv.2011.03.001. Epub 2011 Apr 29.
We report a case of aortitis in a patient with ankylosing spondylitis revealed by an unexplained persistent inflammation.
The diagnosis of ankylosing spondylitis was retained in a 64-year-old woman suffering from inflammatory back and neck pain combined with buttock pain relieved by anti-inflammatory drugs (NSAIDs) since 2004 and more recent bilateral heel pain in the morning since 2006; sacroiliitis was grade 3 on the right and grade 2 on the left (modified New-York criteria). The patient had remained asymptomatic from April 2006 to 2007 with NSAID as needed. Nevertheless, biological inflammation persisted: erythrocyte sedimentation rate 44 to 55 mm/h, activated protein C 34 to 90 mg/L. Complementary examinations are negative: bilateral temporal artery biopsy, endoscopy with duodenal biopsy looking for Tropheryma whipplei. The thoraco-abdominal and pelvic CT scan revealed aortitis extending from the abdominal aorta to the iliac axis. Treatment with prednisone 0.5 mg/kg was started to decrease the inflammatory aortitis.
The most "classical" cardiovascular damage observed in spondylitis is aortic insufficiency and conduction disturbances. The first cases of aortitis were reported in 1958.
Inflammatory vascular disease should be evoked as a possible diagnosis in patients with ankylosing spondylitis the presenting an unexplained biological inflammation (ESR and CRP).
我们报告一例强直性脊柱炎患者发生主动脉炎，由不明原因的持续炎症所揭示。
一名64岁女性被诊断为强直性脊柱炎，自2004年以来患有炎性腰背痛和颈痛，并伴有臀部疼痛，服用抗炎药（非甾体抗炎药）后缓解，自2006年起最近出现双侧足跟晨起疼痛；骶髂关节炎右侧为3级，左侧为2级（改良纽约标准）。2006年4月至2007年期间，患者按需服用非甾体抗炎药时无症状。然而，生物学炎症持续存在：红细胞沉降率为44至55毫米/小时，活化蛋白C为34至90毫克/升。辅助检查均为阴性：双侧颞动脉活检、十二指肠活检的内镜检查以寻找惠普尔嗜组织细胞菌。胸腹盆腔CT扫描显示主动脉炎从腹主动脉延伸至髂动脉轴。开始使用泼尼松0.5毫克/千克进行治疗以减轻炎性主动脉炎。
脊柱炎中观察到的最“典型”心血管损害是主动脉瓣关闭不全和传导障碍。首例主动脉炎于1958年报道。
对于强直性脊柱炎患者出现不明原因的生物学炎症（红细胞沉降率和C反应蛋白）时，应考虑炎性血管疾病作为可能的诊断。
