Clinical profile of Seronegative Spondyloarthropathies with special reference to cardiac involvement
Abstract
Objectives: To study and to classify spondyloarthropathies and to determine the cardiac involvement in patients with spondyloarthropathy (SpA) by ECG and echocardiography.
Material and Methods: A cross-sectional observational study was conducted on 38 patients diagnosed as having seronegative SpA over 12 months. Patients were selected using screening score for diagnosis, detailed history and examination (to exclude arthropathies secondary to trauma, congenital heart defects, cardiac surgeries, other connective tissue diseases), and serological tests to exclude rheumatoid arthritis. Patients who were included, were then subjected to historical and clinical evaluation (including joint examination, dermatological and ocular examination), laboratory and radiological investigations alongwith ECG and echocardiography. The data was compiled and analysed using statistical package for social sciences (SPSS v/s 18).
Results: Out of 38 patients, male to female ratio was 2.45:1; 31.6% belonged to 21-30 years age group. 68.4% had symptoms of spondyloarthropathy since 1-10 years. Ankylosing spondylitis was the commonest SpA ocurring in 73.7%. Occurrence of articular manifestations was 100%; main joint affected was sacro–iliac joint alongwith spine in 92.1% followed by knee joint (87%), then ankle, shoulder, wrist and elbow joint in decreasing order of frequency. As opposed to this, extra articular manifestations were seen in 39.0%. ECG abnormalities such as ST segment changes and rhythm disturbances were noted in 6 patients with aortic regurgitation. ESR and CRP were raised in 90%. Echocardiography was normal in 21%. Among the rest, mitral valve involvement (prolapse,
myxomatous valve, regurgitation) was highest (47.3%) followed by aortic valve (regurgitation, thickening, bicuspid aortic valve).
References
2. Handa R. Approach to seronegative arthritis. JIACM. 2003;4(3):190–2.
3. Packham JC, Bowness P. Seronegative Spondyloarthropathies. Collected reports on the rheumatic diseases, March 2005;Series 4 (Revised): 21-28.
4. Joel DT, The Spondyloathritides; Anthony SF, Eugene B, Dennis LK, Stephen LH, Dan LL, Jameson JL, Eds, Harrison’s Principles of Internal Medicine 17th Edition, McGraw Hill Medical Publications, 2008; 2109 – 2119.
5. Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM, Weisman MH. Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis. 2007; 66(5):633 – 8.
6. Kim TH, Lee HS, Ji JD, Jun JB, Jung S,Bae SC, Yoo DH, Kim SY. Undifferentiated Spondyloarthropathy in Korea- Focusing on Peripheral Arthritis. J Korean Med Sci. 2002; 17(1):71-4.
7. de Almeida FA, AlbanesiFilho FM, de Albuquerque EM, Magalhaes EC, de Menezes ME. Echocardiography in the evaluation of cardiac involvement in seronegativespondyloarthropathies, Medicina (B Aires). 1995;55(3):231 – 6.
8. Bergfeldt L. HLA-B27–associated cardiac disease. Ann Intern Med.1997; 127:621.
9. Dik VK, Peters MJ, Dijkmans PA, Van der Weijden MA, De Vries MK, Dijkmans BA, et al. The relationship between disease- related characteristics and conduction disturbances in ankylosing spondylitis.Scand J Rheumatol. 2010; 39(1):38-41.
10. Yuan SM.Cardiovascular involvement of ankylosing spondylitis: report of three cases. Vascular. 2009; 17(6): 342 – 54.
11. Mukherjee. S, Kar M. Reactive arthritis: Current perspectives, Journal, Indian Academy of Clinical Medicine. Oct – Dec, 2000;1(3):233-8.
12. Brown MA, Pile KD, Kennedy LG, et al. HLA class I associations of ankylosing spondylitis in the white population in the United Kingdom. Ann Rheum Dis. 1996;55(4):268-70.
13. Leirisalo M, Skylv G, Kousa M, et al. Followup study on patients with Reiter’s disease and reactive arthritis, with special reference to LA-B27. Arthritis Rheum. 1982;25(3):249-59.
14. De Vos M, Mielants H, Cuvelier C, Elewaut A, Veys E. Longterm evolution of gut inflammation in patients with spondyloarthropathy. Gastroenterology. 1996;110(6):1696-703.
15. Bergfeldt L, Insulander P, Lindblom D, Moller E, Edhag O. HLA-B27: an important genetic risk factor for lone aortic regurgitation and severe conduction system abnormalities.
Am J Med. 1988; 85(1):12-8.
16. Ropes MW, Bennett GA, Cobb S, Jacox R, Jessar RA. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Arthrits Rheum. 1959; 2: 16-20.
17. Berthelot JM, Klarlund M, Mcgonagle. Lessons from an international survey of paper cases of 10 real patients from an early arthritis clinic. J Rheumatol. 2001; 28: 975-81.
18. Wiles NJ, Lunt M, Barret EM. Reduced disability at 5 years with early treatment of inflammatory arthritis. Arthritis Rheum. 2001; 44: 1033-42.
19. Huizinga TW, Machold KP, Breedveld F C, Lipkype, Smolen J S. Criteria for early rheumatoid arthritis: from Bayes’ law revisited to new thoughts on pathogenesis. Arthritis Rheum.
2002; 46: 1155-9.
20. Kyriakos A K, Allan G.Enteropathic Arthritis, In; Stephen AP, Allan G, John FB, Editors, Manual of Rheumatology and Outpatient Orthopaedic Disorders: Diagnosis and Therapy, Lippincott Williams & Wilkins, Philadelphia: 2000, p 389.
21. Wordsworth P. Genes in the spondyloarthropathies. Rheum Dis Clin North Am.1998;24:845 -863.
22. Sims AM, Timms AE, Bruges-Armas J, Burgos-Vargas R, Chou CT, et al. (2008) Prospective meta-analysis of IL-1 gene complex polymorphisms confirms associations with ankylosing spondylitis. Ann Rheum Dis.2008; 67: 1305–1309.
23. Chaudhary SPR, Singh T, Kaur I, Suri S, Sehgal S, Kaur S. Clinical Profile of Psoriatic Arthropathy. Ind J DermatolVenereolLepr. 1990; 56:200 – 203.
24. Malaviya AN, Dasgupta B, Tiwari SC, Khan KM, Pasricha JS, Mehra NK. Psoriatic Arthritis: A Clinical and Immunological Study in 15 Cases from India. JAPI. 1984;32(5): 403-405.
25. Eric SS.Ankylosing Spondylitis, In; Stephen AP, Allan G, John FB, Eds, Manual of Rheumatology and Outpatient Orthopaedic Disorders: Diagnosis and Therapy, Lippincott Williams & Wilkins, Philadelphia: 2000, p 368.
26. Kalam A, Bhargava SK, et al. Psoriatic arthritis- A clinico radiological study. Indian J Dermatol. 1987; 32 (3): 57-62.
27. Hess E.V. and Fitzgerald O.M. “Psoriatic Arthritis” In: Cohen, BennetEds, Rheumatology and immunology, 3rd ed. Grune and Stratton Inc, 1986, 234.
28. Bohm M, Riemann B, Luger TA, Bonsmann G. Bilateral upper limb lymphoedema associated with psoriatic arthritis: a case report and review of the literature. Br J Dermatol. 2000; 143: 1297 – 1301.
29. Gaikwad S, Hakim AS, Paidhunghat JV, Krishankumari K. Amyloidosis- A Rare Complication of Psoriasis. JAPI. 1994; 42(8):639-640.