Lam S M, Ho H H, Dunn P, Luo S F
Taiwan Yi Xue Hui Za Zhi. 1989 Jul;88(7):726-8.
Multiple myeloma has rarely been reported in patients with ankylosing spondylitis. We observed a patient with a 20-year history of ankylosing spondylitis, who subsequently developed IgA myeloma. This association may not be simply coincidental. It has been proposed that the protracted stimulation of immunocytes by inflammatory lesions on the mucosal surfaces of the gastrointestinal, respiratory, and biliary tracts, where lymphocytes are already committed to IgA production, may be implicated in the pathogenesis of IgA myeloma in some patients. Ankylosing spondylitis is a chronic inflammatory disease, probably resulting from the interaction of a genetic predisposition involving HLA-B27 with an environmental event such as enteric bacterial infection. We propose that ankylosing spondylitis and IgA myeloma occurring concomitantly in our patient implies a possible pathogenetic relationship. In ankylosing spondylitis, persistent reticuloendothelial stimulation, due to chronic subclinical gastrointestinal infection, may lead to IgA-producing plasma cell activation and proliferation, and subsequent IgA myeloma development.
强直性脊柱炎患者中很少有多发性骨髓瘤的报道。我们观察到一名有20年强直性脊柱炎病史的患者，随后发展为IgA骨髓瘤。这种关联可能并非偶然。有人提出，胃肠道、呼吸道和胆道黏膜表面的炎症病变对免疫细胞的长期刺激，可能与某些患者IgA骨髓瘤的发病机制有关，因为这些部位的淋巴细胞已经倾向于产生IgA。强直性脊柱炎是一种慢性炎症性疾病，可能是由涉及HLA - B27的遗传易感性与诸如肠道细菌感染等环境因素相互作用引起的。我们认为，我们的患者同时发生强直性脊柱炎和IgA骨髓瘤意味着可能存在致病关系。在强直性脊柱炎中，由于慢性亚临床胃肠道感染导致的持续网状内皮系统刺激，可能会导致产生IgA的浆细胞活化和增殖，进而发展为IgA骨髓瘤。
