RESUMEN
OBJECTIVE: To investigate whether seemingly healthy first-degree relatives of patients with ankylosing spondylitis (AS) have clinical, laboratory, or imaging features of spondyloarthritis (SpA). METHODS: First-degree relatives (ages 18-40 years) of HLA-B27-positive AS patients were included in the pre-spondyloarthritis (Pre-SpA) cohort, a prospective inception cohort study. Clinical, biologic, and imaging features were recorded. First-degree relatives were classified according to several sets of SpA classification criteria. RESULTS: We report baseline features of 51 first-degree relatives included in this study. Twenty-nine (57%) had back pain, 2 (4%) had psoriasis, 1 (2%) had inflammatory bowel disease, and 1 (2%) had uveitis. Three (6%) had low-grade sacroiliitis, 1 (2%) had cervical syndesmophytes on radiography, and 10 (20%) had bone marrow edema on magnetic resonance imaging of the sacroiliiac joints. Seventeen of 51 first-degree relatives (33%) fulfilled SpA classification criteria: 7 (14%) fulfilled both Assessment of SpondyloArthritis international Society (ASAS) axial SpA and European Spondylarthropathy Study Group (ESSG) classification criteria, 6 (12%) fulfilled only ASAS axial SpA classification criteria, and 4 (8%) fulfilled only ESSG classification criteria; 3 (6%) also fulfilled the Amor criteria. None fulfilled other SpA classification criteria. First-degree relatives fulfilling the ASAS axial SpA and/or ESSG classification criteria had more frequent inflammatory back pain, had a higher level of disease activity, and had more psoriasis. No differences were found in parameters of inflammation, peripheral and extraarticular disease other than psoriasis, and HLA-B27 positivity between those who did and those who did not fulfill the ASAS axial SpA and/or ESSG classification criteria. Four first-degree relatives (12%) who did not fulfill the ASAS axial SpA and/or ESSG classification criteria had imaging abnormalities suggestive of SpA. CONCLUSION: A substantial proportion of seemingly healthy first-degree relatives of HLA-B27-positive AS patients have clinical and/or imaging abnormalities suggestive of SpA. Thirty-three percent could be classified as having SpA. Further follow-up will show which first-degree relatives will develop clinically manifest SpA.
Asunto(s)
Dolor de Espalda/epidemiología , Familia , Enfermedades Inflamatorias del Intestino/epidemiología , Psoriasis/epidemiología , Sacroileítis/epidemiología , Espondiloartropatías/diagnóstico por imagen , Espondilitis Anquilosante , Uveítis/epidemiología , Adolescente , Adulto , Enfermedades de la Médula Ósea/diagnóstico por imagen , Enfermedades de la Médula Ósea/epidemiología , Estudios de Cohortes , Edema/diagnóstico por imagen , Edema/epidemiología , Femenino , Antígeno HLA-B27/genética , Humanos , Imagen por Resonancia Magnética , Masculino , Osteofito/diagnóstico por imagen , Osteofito/epidemiología , Estudios Prospectivos , Radiografía , Sacroileítis/diagnóstico por imagen , Espondiloartropatías/fisiopatología , Espondilitis Anquilosante/genética , Adulto JovenRESUMEN
Cardiac involvement is very common in patients with systemic lupus erythematosus since 30 to 50% of all patients suffer from some sort of heart disease (Lahita, Textbook of rheumatology, 1997). Pericarditis is the most common form of involvement and occurs in 19 to 48% of patients (Lahita, Textbook of rheumatology, 1997). Pleural and/or pericardial pain can occur in any phase of the disease; however, pericardial effusion leading to cardiac tamponade is rare (Lahita, Textbook of rheumatology, 1997; Lee et al., Journal of Korean Medical Science 12(1):75-77, 1997). We report such a case, illustrated by echocardiography.