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Pulmonary, renal and neurological comorbidities in patients with ankylosing spondylitis; implications for clinical practice

  • Spondyloarthritis (MA Khan, Section Editor)
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Abstract

Ankylosing spondylitis (AS) is associated with several comorbidities which contribute significantly to morbidity and mortality and add to the complexity of management. In addition to the well known extra-articular manifestations and increased cardiovascular risk, several pulmonary, renal, and neurological complications which have been associated with AS deserve equal attention. Whereas a clear link has been established for some manifestations, the evidence for other associations is less clear. Interstitial lung disease, apical fibrosis, secondary infection, and ventilatory restriction from reduced chest wall movement are well known pulmonary complications; more recently an association with sleep apnoea has been suggested. Renal amyloidosis and IgA nephropathy remain a treatment challenge which may respond to anti-TNF therapy. Atlanto axial subluxation and vertebral fractures can result in serious neurological complications and are notoriously difficult to diagnose unless a high level of suspicion is maintained. Despite several reports linking AS with demyelination a true link remains to be proved. This review discusses the prevalence, pathophysiology, and management of pulmonary, renal, and neurological complications, and implications for clinical practice.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.

    PubMed  Google Scholar 

  2. Dean LE, Jones GT, Macdonald AG, et al. Global prevalence of ankylosing spondylitis. Rheumatology. 2014;53:650–7.

    PubMed  Google Scholar 

  3. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.

    CAS  PubMed  Google Scholar 

  4. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70:25–31.

    CAS  PubMed  Google Scholar 

  5. Van der Horst-Bruinsma IE, Nurmohamed MT, Landewé RB. Comorbidities in patients with spondyloarthritis. Rheum Dis Clin N Am. 2012;38:523–38. A comprehensive review of the commonest comorbidities in SpA.

    Google Scholar 

  6. Valderas JM, Starfield B, Sibbald B, et al. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7:357–63.

    PubMed Central  PubMed  Google Scholar 

  7. El Maghraoui A, Dehhaoui M. Prevalence and characteristics of lung involvement on high resolution computed tomography in patients with ankylosing spondylitis: a systematic review. Pulm Med. 2012;2012:965956. A good review of radiologically defined abnormalities in AS.

    PubMed Central  PubMed  Google Scholar 

  8. Erb N, Karokis D, Delamere JP, et al. Obstructive sleep apnoea as a cause of fatigue in ankylosing spondylitis. Ann Rheum Dis. 2003;62:183–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Solak O, Fidan F, Dündar U, et al. The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients. Rheumatology. 2009;48:433–5.

    PubMed  Google Scholar 

  10. Strobel ES, Fritschka E. Renal diseases in ankylosing spondylitis: review of the literature illustrated by case reports. Clin Rheumatol. 1998;17:524–30.

    CAS  PubMed  Google Scholar 

  11. Levy AR, Szabo SM, Rao SR, et al. Estimating the occurrence of renal complications among persons with ankylosing spondylitis. Arthritis Care Res. 2014;66:440–5. A well-designed population study estimating the prevalence of renal complications in AS.

    Google Scholar 

  12. Lee JS, Lee S, Bang SY, et al. Prevalence and risk factors of anterior atlantoaxial subluxation in ankylosing spondylitis. J Rheumatol. 2012;39:2321–6.

    CAS  PubMed  Google Scholar 

  13. Chaudhary SB, Hullinger H, Vives MJ. Management of acute spinal fractures in ankylosing spondylitis. ISRN Rheumatol. 2011;2011:150484.

    PubMed Central  PubMed  Google Scholar 

  14. van der Weijden MA, van der Horst-Bruinsma IE, van Denderen JC, et al. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int. 2012;23(6):1683–90.

    PubMed  Google Scholar 

  15. Bron JL, de Vries MK, Snieders MN, et al. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol. 2009;28(8):883–92.

    PubMed Central  PubMed  Google Scholar 

  16. El-Maghraoui A, Chaouir S, Bezza A, et al. Thoracic high resolution computed tomography in patients with ankylosing spondylitis and without respiratory symptoms. Ann Rheum Dis. 2003;62(2):185–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  17. Davies D. Lung fibrosis in ankylosing spondylitis. Thorax. 1972;27:262.

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Sampaio-Barros PD, Cerqueira EM, Rezende SM, et al. Pulmonary involvement in ankylosing spondylitis. Clin Rheumatol. 2007;26:225–30.

    PubMed  Google Scholar 

  19. Turetschek K, Ebner W, Fleischmann D, et al. Early pulmonary involvement in ankylosing spondylitis: assessment with thin-section CT. Clin Radiol. 2000;55:632–6.

    CAS  PubMed  Google Scholar 

  20. Kiris A, Ozgocmen S, Kocakoc E, et al. Lung findings on high resolution CT in early ankylosing spondylitis. Eur J Radiol. 2003;47:71–6.

    PubMed  Google Scholar 

  21. Berdal G, Halvorsen S, van der Heijde D, et al. Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study. Arthritis Res Ther. 2012;14:R19.

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Dincer U, Cakar E, Kiralp MZ, Bozkanat E, et al. The pulmonary involvement in rheumatic diseases: pulmonary effects of ankylosing spondylitis and its impact on functionality and quality of life. Tohoku J Exp Med. 2007;212:423–30.

    PubMed  Google Scholar 

  23. Tanoue LT. Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjögren’s syndrome, and relapsing polychondritis. J Thorac Imaging. 1992;7:62–77.

    CAS  PubMed  Google Scholar 

  24. Kanathur N, Lee-Chiong T. Pulmonary manifestations of ankylosing spondylitis. Clin Chest Med. 2010;31:547–54.

    PubMed  Google Scholar 

  25. Ho HH, Lin MC, Yu KH, et al. Pulmonary tuberculosis and disease-related pulmonary apical fibrosis in ankylosing spondylitis. J Rheumatol. 2009;36:355–60.

    PubMed  Google Scholar 

  26. Momeni M, Taylor N, Tehrani M. Cardiopulmonary manifestations of ankylosing spondylitis. Int J Rheumatol. 2011;2011:728471.

    PubMed Central  PubMed  Google Scholar 

  27. El Maghraoui A. Pleuropulmonary involvement in ankylosing spondylitis. Joint Bone Spine. 2005;72:496–502.

    PubMed  Google Scholar 

  28. Donath J, Miller A. Restrictive chest wall disorders. Semin Respir Crit Care Med. 2009;30:275–92.

    PubMed  Google Scholar 

  29. Fisher LR, Cawley MI, Holgate ST. Relation between chest expansion, pulmonary function, and exercise tolerance in patients with ankylosing spondylitis. Ann Rheum Dis. 1990;49:921–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  30. Altin R, Ozdolap S, Savranlar A, et al. Comparison of early and late pleuropulmonary findings of ankylosing spondylitis by high-resolution computed tomography and effects on patients’ daily life. Clin Rheumatol. 2005;24:22–8.

    PubMed  Google Scholar 

  31. Sahin G, Guler H, Calikoglu M, et al. A comparison of respiratory muscle strength, pulmonary function tests and endurance in patients with early and late stage ankylosing spodylitis. Z Rheumatol. 2006;65:535–538, 540.

  32. Deodhar A, Braun J, Inman RD, et al. Golimumab reduces sleep disturbance in patients with active ankylosing spondylitis: results from a randomized, placebo-controlled trial. Arthritis Care Res. 2010;62:1266–71.

    Google Scholar 

  33. Rudwaleit M, Gooch K, Michel B, et al. Adalimumab improves sleep and sleep quality in patients with active ankylosing spondylitis. J Rheumatol. 2011;38:79–86.

    PubMed  Google Scholar 

  34. Louie GH, Ward MM. Measurement and treatment of radiographic progression in ankylosing spondylitis: lessons learned from observational studies and clinical trials. Curr Opin Rheumatol. 2014;26:145–50.

    PubMed  Google Scholar 

  35. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.

    CAS  PubMed  Google Scholar 

  36. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28:596–602.

    CAS  PubMed  Google Scholar 

  37. Heiberg T, Lie E, van der Heijde D, et al. Sleep problems are of higher priority for improvement for patients with ankylosing spondylitis than for patients with other inflammatory arthropathies. Ann Rheum Dis. 2011;70:872–3.

    PubMed  Google Scholar 

  38. Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proc Am Thorac Soc. 2008;5:136–43.

    PubMed Central  PubMed  Google Scholar 

  39. Walsh JA, Duffin KC, Crim J, et al. Lower frequency of obstructive sleep apnea in spondyloarthritis patients taking TNF-inhibitors. J Clin Sleep Med. 2012;8:643–8.

    PubMed Central  PubMed  Google Scholar 

  40. Ryan S, Taylor CT, McNicholas WT. Predictors of elevated nuclear factor-kappaB-dependent genes in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2006;174:824–30.

  41. Loubaki L, Jacques E, Semlali A, et al. Tumor necrosis factor-alpha expression in uvular tissues differs between snorers and apneic patients. Chest. 2008;134:911–8.

  42. Garvey JF, Taylor CT, McNicholas WT. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation. Eur Respir J. 2009;33:1195–205.

  43. Kapsimalis F, Basta M, Varouchakis G, et al. Cytokines and pathological sleep. Sleep Med. 2008;9:603–14.

  44. Kang JH, Lin HC. Obstructive sleep apnea and the risk of autoimmune diseases: a longitudinal population-based study. Sleep Med. 2012;13:583–8.

  45. Jennum P, Kjellberg J. Health, social and economic consequences of sleep-disordered breathing: a controlled national study. Thorax. 2011;66:560–6.

  46. Vilar MJ, Cury SE, Ferraz MB, et al. Renal abnormalities in ankylosing spondylitis. Scand J Rheumatol. 1997;26:19–23.

    CAS  PubMed  Google Scholar 

  47. Shu KH, Lian JD, Yang YF, et al. Glomerulonephritis in ankylosing spondylitis. Clin Nephrol. 1986;25:169–74.

    CAS  PubMed  Google Scholar 

  48. Gupta R, Sharma A, Arora R, et al. Membranous glomerulonephritis in a patient with ankylosing spondylitis: a rare association. Clin Exp Nephrol. 2009;13:667–70.

    PubMed  Google Scholar 

  49. Lee SH, Lee EJ, Chung SW, et al. Renal involvement in ankylosing spondylitis: prevalence, pathology, response to TNF-a blocker. Rheumatol Int. 2013;33:1689–92.

    CAS  PubMed  Google Scholar 

  50. Whelton A. Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications. Am J Med. 1999;106(5B):13S–24.

    CAS  PubMed  Google Scholar 

  51. Murray MD, Brater DC. Renal toxicity of the nonsteroidal anti-inflammatory drugs. Annu Rev Pharmacol Toxicol. 1993;33:435–65.

    CAS  PubMed  Google Scholar 

  52. Lehtinen K. Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis. Ann Rheum Dis. 1993;52:174–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  53. Gallinaro AL, Ventura C, Barros PD, et al. Spondyloarthritis: analysis of a Brazilian series compared with a large Ibero-American registry (RESPONDIA group). Rev Bras Reumatol. 2010;50:581–9.

    PubMed  Google Scholar 

  54. Dönmez S, Pamuk ÖN, Pamuk GE, et al. Secondary amyloidosis in ankylosing spondylitis. Rheumatol Int. 2013;33:1725–9.

    PubMed  Google Scholar 

  55. Gratacós J, Collado A, Sanmartí R, et al. Coincidental amyloid nephropathy and IgA glomerulonephritis in a patient with ankylosing spondylitis. J Rheumatol. 1993;20:1613–5.

    PubMed  Google Scholar 

  56. Singh G, Kumari N, Aggarwal A, et al. Prevalence of subclinical amyloidosis in ankylosing spondylitis. J Rheumatol. 2007;34:371–3.

    PubMed  Google Scholar 

  57. Immonen K, Finne P, Grönhagen-Riska C, et al. A marked decline in the incidence of renal replacement therapy for amyloidosis associated with inflammatory rheumatic diseases - data from nationwide registries in Finland. Amyloid. 2011;18:25–8.

    PubMed  Google Scholar 

  58. Immonen K, Finne P, Hakala M, et al. No improvement in survival of patients with amyloidosis associated with inflammatory rheumatic diseases – data from the Finnish national registry for kidney diseases. J Rheumatol. 2008;35:1334–8.

    PubMed  Google Scholar 

  59. Hawkins PN. Diagnosis and treatment of amyloidosis. Ann Rheum Dis. 1997;56:631–3.

    CAS  PubMed Central  PubMed  Google Scholar 

  60. Hazenberg BP, van Rijswijk MH. Clinical and therapeutic aspects of AA amyloidosis. Baillieres Clin Rheumatol. 1994;8:661–90.

    CAS  PubMed  Google Scholar 

  61. Perry ME, Stirling A, Hunter JA. Effect of etanercept on serum amyloid A protein (SAA) levels in patients with AA amyloidosis complicating inflammatory arthritis. Clin Rheumatol. 2008;27:923–5.

    CAS  PubMed  Google Scholar 

  62. Kobak S, Oksel F, Kabasakal Y, et al. Ankylosing spondylitis-related secondary amyloidosis responded well to etanercept: a report of three patients. Clin Rheumatol. 2007;26:2191–4.

    PubMed  Google Scholar 

  63. Urieli-Shoval S, Linke RP, Matzner Y. Expression and function of serum amyloid A, a major acute-phase protein, in normal and disease states. Curr Opin Hematol. 2000;7:64–9.

    CAS  PubMed  Google Scholar 

  64. Yan SD, Zhu H, Zhu A, et al. Receptor-dependent cell stress and amyloid accumulation in systemic amyloidosis. Nat Med. 2000;6:643–51.

    CAS  PubMed  Google Scholar 

  65. Cunnane G. Amyloid proteins in pathogenesis of AA amyloidosis. Lancet. 2001;358:4–5.

    CAS  PubMed  Google Scholar 

  66. Gottenberg JE, Merle-Vincent F, Bentaberry F, et al. Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a follow up report of tolerability and efficacy. Arthritis Rheum. 2003;48(7):2019–24.

    CAS  PubMed  Google Scholar 

  67. De Vries MK, van Eijk IC, van der Horst-Bruinsma IE, et al. Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid A protein for patient selection and monitoring of Anti-Tumor necrosis Factor treatment in ankylosing spondylitis. Arthritis Rheum. 2009;61(11):1484–90.

    PubMed  Google Scholar 

  68. McCarthy ET, Sharma R, Sharma M, et al. TNF-alpha increases albumin permeability of isolated rat glomeruli through the generation of superoxide. J Am Soc Nephrol. 1998;9:433–8.

    CAS  PubMed  Google Scholar 

  69. Jacquet A, Francois H, Frangie C, et al. IgA nephropathy associated with ankylosing spondylitis is not controlled by infliximab therapy. Nephrol Dial Transplant. 2009;24:3540–2.

    CAS  PubMed  Google Scholar 

  70. Fernández-Nebro A, Tomero E, Ortiz-Santamaría V, et al. Treatment of rheumatic inflammatory disease in 25 patients with secondary amyloidosis using tumor necrosis factor alpha antagonists. Am J Med. 2005;118:552–6.

    PubMed  Google Scholar 

  71. Donadio JV, Grande JP. IgA nephropathy. N Engl J Med. 2002;347:738–48.

    CAS  PubMed  Google Scholar 

  72. Haddad E, Moura IC, Arcos-Fajardo M, et al. Enhanced expression of the CD71 mesangial IgA1 receptor in Berger disease and Henoch-Schönlein nephritis: association between CD71 expression and IgA deposits. J Am Soc Nephrol. 2003;14:327–37.

    CAS  PubMed  Google Scholar 

  73. Ahn NU, Ahn UM, Nallamshetty L, et al. Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): meta-analysis of outcomes after medical and surgical treatments. J Spinal Disord. 2001;14:427–33.

    CAS  PubMed  Google Scholar 

  74. Oh DH, Jun JB, Kim HT, et al. Transverse myelitis in a patient with long-standing ankylosing spondylitis. Clin Exp Rheumatol. 2001;19:195–6.

    CAS  PubMed  Google Scholar 

  75. Libbrecht N, De Bleecker J. Ankylosing spondylitis and multiple sclerosis. Acta Clin Belg. 1999;54:30–2.

    CAS  PubMed  Google Scholar 

  76. Thumbikat P, Hariharan RP, Ravichandran G, et al. Spinal cord injury in patients with ankylosing spondylitis: a 10-year review. Spine. 2007;32:2989–95.

    PubMed  Google Scholar 

  77. Lui NL, Inman RD. Atlanto-axial subluxation as the initial manifestation of spondyloarthritis. Joint Bone Spine. 2011;78:415–7.

    PubMed  Google Scholar 

  78. Ramos-Remus C, Gomez-Vargas A, Hernandez-Chavez A, et al. Two year follow up of anterior and vertical atlantoaxial subluxation in ankylosing spondylitis. J Rheumatol. 1997;24:507–10.

    CAS  PubMed  Google Scholar 

  79. Albert GW, Menezes AH. Ankylosing spondylitis of the craniovertebral junction: a single surgeon’s experience. J Neurosurg Spine. 2011;14:429–36.

    PubMed  Google Scholar 

  80. Khan MA, Kushner I. Ankylosing spondylitis and multiple sclerosis: a possible association. Arthritis Rheum. 1979;22:784–6.

    CAS  PubMed  Google Scholar 

  81. Calin A. Is there an association between ankylosing spondylitis and multiple sclerosis? Ann Rheum Dis. 1989;48:971–2.

    CAS  PubMed Central  PubMed  Google Scholar 

  82. Wendling D, Flipo RM, Breban M, et al. Coexistence of spondyloarthropathy and multiple sclerosis: a series of 21 cases. Ann Rheum Dis. 2008;67:901–3. The largest case series of patients with coexisting SpA and MS.

    CAS  PubMed  Google Scholar 

  83. Mercieca C, Vella N, Borg AA. Demyelination during anti-TNFα therapy for ankylosing spondylitis. Mod Rheumatol. 2012;22:303–7.

    PubMed  Google Scholar 

  84. Pfueller CF, Seipelt E, Zipp F, et al. Multiple sclerosis following etanercept treatment for ankylosing spondylitis. Scand J Rheumatol. 2008;37:397–9.

    CAS  PubMed  Google Scholar 

  85. Seror R, Richez C, Sordet C, et al. Pattern of demyelination occurring during anti-TNF-α therapy: a French national survey. Rheumatology. 2013;52:868–74.

    CAS  PubMed  Google Scholar 

  86. Brinar VV, Petelin Z, Brinar M, et al. CNS demyelination in autoimmune diseases. Clin Neurol Neurosurg. 2006;108:318–26.

    PubMed  Google Scholar 

  87. Barcellos LF, Kamdar BB, Ramsay PP, et al. Clustering of autoimmune diseases in families with a high-risk for multiple sclerosis: a descriptive study. Lancet Neurol. 2006;5:924–31.

    CAS  PubMed  Google Scholar 

  88. Midgard R, Grønning M, Riise T, et al. Multiple sclerosis and chronic inflammatory diseases. A case–control study. Acta Neurol Scand. 1996;93:322–8.

    CAS  PubMed  Google Scholar 

  89. O’Rielly DD, Rahman P. Advances in the genetics of spondyloarthritis and clinical implications. Curr Rheumatol Rep. 2013;15:347.

    PubMed  Google Scholar 

  90. Lincoln MR, Montpetit A, Cader MZ, et al. A predominant role for the HLA class II region in the association of the MHC region with multiple sclerosis. Nat Genet. 2005;37(10):1108–12.

    CAS  PubMed  Google Scholar 

  91. Liu M, Hu X, Wang Y, et al. Association of IL-23 and its receptor gene single-nucleotide polymorphisms with multiple sclerosis in Chinese southern population. Int J Neurosci. 2014 Mar 19. [Epub ahead of print]

  92. Begovich AB, Chang M, Caillier SJ, et al. The autoimmune disease-associated IL12B and IL23R polymorphisms in multiple sclerosis. Hum Immunol. 2007;68:934–7.

    CAS  PubMed  Google Scholar 

  93. Oksenberg JR, Panzara MA, Begovich AB, et al. Selection for T-cell receptor V beta-D beta-J beta gene rearrangements with specificity for a myelin basic protein peptide in brain lesions of multiple sclerosis. Nature. 1993;362:68.

    CAS  PubMed  Google Scholar 

  94. Langrish CL, Chen Y, Blumenschein WM, et al. IL-23 drives a pathogenic T cell population that induces autoimmune inflammation. J Exp Med. 2005;201:233.

    CAS  PubMed Central  PubMed  Google Scholar 

  95. Hreggvidsdottir HS, Noordenbos T, Baeten DL. Inflammatory pathways in spondyloarthritis. Mol Immunol. 2014;57:28–37.

    CAS  PubMed  Google Scholar 

  96. Magnano MD, Robinson WH, Genovese MC. Demyelination and inhibition of tumor necrosis factor (TNF). Clin Exp Rheumatol. 2004;22:S134–40.

    CAS  PubMed  Google Scholar 

  97. Ruddle NH, Bergman CM, McGrath KM, et al. An antibody to lymphotoxin and tumor necrosis factor prevents transfer of experimental allergic encephalomyelitis. J Exp Med. 1990;172:1193–200.

    CAS  PubMed  Google Scholar 

  98. The Lenercept Multiple Sclerosis Study Group and the University of British Columbia MS/MRI Analysis Group. TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. Neurology. 1999;53:457–65.

    Google Scholar 

  99. van Oosten BW, Barkhof F, Truyen L, et al. Increased MRI activity and immune activation in two multiple sclerosis patients treated with the monoclonal anti-tumor necrosis factor antibody cA2. Neurology. 1996;47:1531–4.

    PubMed  Google Scholar 

  100. Cellerini M, Gabbrielli S, Bongi SM. Cerebral magnetic resonance imaging in a patient with ankylosing spondylitis and multiple sclerosis-like syndrome. Neuroradiology. 2001;43:1067–9.

    CAS  PubMed  Google Scholar 

  101. Whitman GJ, Khan MA. Unusual occurrence of ankylosing spondylitis and multiple sclerosis in a black patient. Cleve Clin J Med. 1989;56:819–22.

    CAS  PubMed  Google Scholar 

  102. Tan FU, Tellioğlu S, Aydin G, et al. Ankylosing spondylitis and multiple sclerosis in an HLA-B27 negative patient. Acta Neurol Belg. 2004;104:169–72.

    PubMed  Google Scholar 

  103. Mignarri A, Dotti MT, Battisti C, et al. Occurrence of ankylosing spondylitis and multiple sclerosis-like syndrome in a HLA-B27 positive patient. Neurol Sci. 2009;30:329–32.

    PubMed  Google Scholar 

  104. Borman P, Tuncay F, Köybaşi M, et al. Coexistence of ankylosing spondylitis and multiple sclerosis. Acta Neurol Belg. 2011;111:340–3.

    PubMed  Google Scholar 

  105. Lourbopoulos A, Ioannidis P, Boura E, et al. Coexistence of multiple sclerosis and ankylosing spondylitis: report of two cases. Eur Neurol. 2013;70:149–54.

    CAS  PubMed  Google Scholar 

  106. Pillay N, Hunter T. Delayed evoked potentials in patients with ankylosing spondylitis. J Rheumatol. 1986;13:137–41.

    CAS  PubMed  Google Scholar 

  107. Hanrahan PS, Russell AS, McLean DR. Ankylosing spondylitis and multiple sclerosis: an apparent association? J Rheumatol. 1988;15:1512–4.

    CAS  PubMed  Google Scholar 

  108. Wade BJ. Spatial analysis of global prevalence of multiple sclerosis suggests need for an updated prevalence scale. Mult Scler Int. 2014;2014:124578.

    PubMed Central  PubMed  Google Scholar 

  109. Kaltsonoudis E, Voulgari PV, Konitsiotis S, et al. Demyelination and other neurological adverse events after anti-TNF therapy. Autoimmun Rev. 2014;13:54–8.

    CAS  PubMed  Google Scholar 

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Cecilia Mercieca, Irene E. van der Horst-Bruinsma, and Andrew A. Borg declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Academic Rheumatology Unit, University Hospitals Bristol, Bristol, BS2 8HW, UK

    Cecilia Mercieca

  2. VU University Medical Center, Room 3A-64, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Irene E. van der Horst-Bruinsma

  3. Department of Rheumatology, Mater Dei Hospital, University of Malta, Msida, Malta

    Andrew A. Borg

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  1. Cecilia Mercieca
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  2. Irene E. van der Horst-Bruinsma
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  3. Andrew A. Borg
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Correspondence to Cecilia Mercieca.

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This article is part of the Topical Collection on Spondyloarthritis

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Mercieca, C., van der Horst-Bruinsma, I.E. & Borg, A.A. Pulmonary, renal and neurological comorbidities in patients with ankylosing spondylitis; implications for clinical practice. Curr Rheumatol Rep 16, 434 (2014). https://doi.org/10.1007/s11926-014-0434-7

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