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Rheumatology Advance Access published online on August 16, 2005
Rheumatology, doi:10.1093/rheumatology/kei077
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received May 16, 2005
Accepted July 14, 2005

Concise Report

Spontaneous pneumothorax associated with ankylosing spondylitis

C.-C. Lee 1, S.-H. Lee 2, I.-J. Chang 3, T.-C. Lu 1, A. Yuan 1, T.-A. Chang 4, K.-C. Tsai 2, and W.-J. Chen 2*

1 Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
2 Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
3 Institute of Preventive Medicine, School of Public Health, National Taiwan University and Taipei City Hospital, Renai Branch, Taipei, Taiwan
4 Department of Pathology, Taipei City Hospital, Renai Branch, Taipei, Taiwan

* To whom correspondence should be addressed.
W.-J. Chen, E-mail: jone{at}ha.mc.ntu.edu.tw


  Abstract

Objective. To review the incidence and clinical characteristics of spontaneous pneumothorax in patients with ankylosing spondylitis (AS).

Methods. This is a retrospective observational cohort study. Chest radiographs and medical records of patients with a diagnosis of AS from 1993 to 2003 in a tertiary referral centre were reviewed.

Results. A total of 1028 patients with a diagnosis of AS were identified from July 1993 to July 2003. Twenty-two patients had typical apical lung fibrotic changes in the chest radiographs (22/1028, 2.1%). Three of these patients (3/22, 13.6%) with lung disease had pneumothorax. Two patients had recurrences and received video-assisted thoracoscopic surgery (VATS) on the second attack. The third patient received talc pleurodesis on the first attack and did not have a recurrence. The incidence of spontaneous pneumothorax in patients with AS was 0.29% (3/1028) with an incidence density of 64.85/100000 patient-yr (95% confidence interval: 66.17-63.57/100000).

Conclusion. Spontaneous pneumothorax appears to be exceedingly rare in AS unless there is an underlying fibrocystic lung disease, in which case its occurrence is not uncommon. Cigarette smoking may be an important co-factor. Once developed, recurrences are common even after treatment. Prophylactic procedures should thus be considered for the first attack of spontaneous pneumothorax.

Keywords: Ankylosing spondylitis; Spontaneous pneumothorax.
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