title: Retroperitoneal fibrosis and ankylosing spondylitis: which links?
abstract: OBJECTIVE
  To report a case of retroperitoneal fibrosis (RPF) in a patient with ankylosing spondylitis (AS) and to review the medical literature for similar cases to detect possible links between the 2 diseases.
  
  
  METHODS
  The presentation, clinical course, diagnostic work-up, and treatment of our patient are described, and the English and French medical literature from 1960 to 2000 is reviewed using a MEDLINE search for cases with coexisting RPF and spondyloarthritis.
  
  
  RESULTS
  Our patient with AS had RPF, which mimicked rectal cancer with retroperitoneal and vertebral metastases. Special attention is paid to the unusual clinical presentation, the multistep diagnostic process, and the therapeutic strategy which was both radiologically and histologically successful. Literature review revealed 18 cases of concomitant RPF and spondyloarthritis, mainly AS. Patients were more frequently male (M/F, 3/1) and developed spondyloarthritis several years before RPF.
  
  
  CONCLUSIONS
  RPF may result from a local immune response to products of aortic atheromatous plaques, with subsequent periaortic deposition of fibrous tissue. However, the clinical features and the frequent association with other fibrosing disorders suggest that RPF is a systemic inflammatory condition. The role of AS-associated aortitis in the development of RPF warrants consideration.
authors.affiliation: Department of Internal Medicine, Immunology, and Rheumatology, University Campus Bio-Medico, 00155 Rome, Italy. a.afeltra@unicampus.it
authors.forename: Antonella
authors.initials: A
authors.lastname: Afeltra
authors.forename: Umberto Vespasiani
authors.initials: UV
authors.lastname: Gentilucci
authors.forename: Carla
authors.initials: C
authors.lastname: Rabitti
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
authors.forename: Marco
authors.initials: M
authors.lastname: Caricato
authors.forename: Marta
authors.initials: M
authors.lastname: Vadacca
authors.forename: Sergio
authors.initials: S
authors.lastname: Valeri
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Zardi
authors.forename: Roberto
authors.initials: R
authors.lastname: Coppola
authors.forename: Antonio
authors.initials: A
authors.lastname: Picardi
mesh_terms: D001025:Aortitis / Q000150:complications / Q000473:pathology; D003113:Colonoscopy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012004:Rectal Neoplasms / Q000175:diagnosis; D012185:Retroperitoneal Fibrosis / Q000150:complications / Q000473:pathology* / Q000628:therapy; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000556:secondary; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate