Rheumatology Advance Access published online on January 24, 2008
Rheumatology, doi:10.1093/rheumatology/kem328
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Peripheral inflammatory arthritis in patients with chronic periaortitis: report of five cases and review of the literature
1Department of Clinical Medicine, Nephrology and Health Science, 2Urology Unit, University of Parma, Parma and 3Rheumatology Service, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Correspondence to:
A. Vaglio, Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università degli Studi di Parma, Via Gramsci 14, 43100 Parma, Italy. E-mail: augusto.vaglio{at}virgilio.it
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Abstract |
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Objectives.: Chronic periaortitis (CP) is a rare disease with a potentially immune-mediated pathogenesis. The study aims to report the frequency and the clinical characteristics of peripheral inflammatory arthritis in a cohort of CP patients, and to review the literature regarding the association between arthritis and CP.
Methods.: Forty-nine consecutive CP patients were seen at our department between 2000 and 2006; all of them underwent imaging (abdominal computed tomography and magnetic resonance imaging) and laboratory examinations, also including erythrocyte sedimentation rate, C-reactive protein and a panel of autoantibodies. The clinical history of the patients who developed peripheral inflammatory arthritis is reported in detail. A PubMed/Medline search without any date limits was performed for English-language articles reporting the association between CP and arthritis.
Results.: Five of the 49 enrolled patients developed an inflammatory form of peripheral arthritis: three were diagnosed as having RA, one palindromic rheumatism and one acute reactive arthritis. In all but one case, arthritis became clinically overt months to years after the onset of CP, and its outcome was good, since almost all patients were asymptomatic at the end of follow-up. No patient suffered from ankylosing spondylitis. In the literature review, 20 cases of CP-associated arthritis were found, mainly in the form of case reports: 14 of them were spondyloarthropathies, whereas the remaining ones were RA, juvenile RA or undifferentiated arthritis.
Conclusions.: Peripheral inflammatory arthritis, particularly RA or RA-like forms, may develop in CP patients. This overlap strengthens the hypothesis of an autoimmune origin of CP.
KEY WORDS: Retroperitoneal fibrosis, Inflammatory aneurysms, Rheumatoid arthritis, Autoimmunity, Antinuclear antibodies, Rheumatoid factor
*A. Vaglio and A. Palmisano equally contributed to this work.
Submitted 25 July 2007;
revised version accepted 2 November 2007.
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