title: Abdominal aortitis in HLA-B27+ spondyloarthritis: case report with 5-year follow-up and literature review.
abstract: OBJECTIVE
  Aortic disease is a known complication of HLA-B27-associated spondyloarthritis. We present the case of a 52-year-old HLA-B27-positive woman with aortitis of the abdominal aorta and spondyloarthritis.
  
  
  METHODS
  In addition to the case reported, a literature search (MEDLINE) for articles published between 1946 and September 2013 was performed using combinations of the MEDLINE subject headings keywords "spondylarthritis," "ankylosing spondylitis," "reactive arthritis," "psoriatic arthritis," "aortitis," and "abdominal aorta." Relevant references were retrieved.
  
  
  RESULTS
  
  
  
  METHODS
  Our patient presented to the ER in June 2008 with a 3-week history of worsening of severe cramping lower abdominal pain. Her history also included recurrent acute episodes of iritis, which eventually led to enucleation of her left eye despite treatment with corticosteroids. CT of the abdomen showed findings suggesting aortitis of the abdominal aorta. She responded to therapy with prednisone, and follow-up imaging showed eventual resolution of the aortitis. She later went on to be diagnosed with psoriatic arthritis with spondylitis.
  
  
  METHODS
  Six previously reported cases of abdominal aortitis in spondyloarthritis were found. Four of these were reported in patients with ankylosing spondylitis, one in reactive arthritis, and one in psoriatic arthritis. The first case reported was in 1958 and the most recent in 2012.
  
  
  CONCLUSIONS
  Rheumatologists should be aware of the possibility of abdominal aortitis occurring in their patients with SpA and should consider it as part of the differential diagnosis in a SpA patient with unexplained visceral pain or systemic features out of proportion to clinically apparent disease.
authors.affiliation: University of British Columbia, Vancouver, Canada. Electronic address: gsgrewal@alumni.ubc.ca.
authors.forename: Gurinder S
authors.initials: GS
authors.lastname: Grewal
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Alice V
authors.initials: AV
authors.lastname: Klinkhoff
mesh_terms: D001012:Aorta, Abdominal; D001025:Aortitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D015796:HLA-B27 Antigen / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D025241:Spondylarthritis / Q000150:complications* / Q000276:immunology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D059265:Visceral Pain / Q000209:etiology
chemical_list: D015796:HLA-B27 Antigen; D011241:Prednisone
keywords: Abdominal aorta; Ankylosing spondylitis; Aortitis; HLA-B27; Large vessel; Psoriatic arthritis; Reactive arthritis; Spondyloarthritis; Vasculitis