AS in females - The early literature suggested that AS was an overwhelmingly male disease. The actual male-to-female ratio is approximately 2:1 to 3:1. There is probably no clear difference between men and women in the clinical and radiographic features of AS, although women with AS may have more involvement of the cervical spine and peripheral joints than do men
女性和男性的臨床和放射學上表現類似。但女性有較高的頸椎和周邊關節的侵犯。
Cardiovascular disease - Although predominantly an arthritis, AS is related to cardiovascular diseases in two ways: AS is associated with a higher risk for cardiovascular diseases. This was illustrated in a cross-sectional study of 720 AS patients and four times that number of controls matched in age, gender, and geography [45]. The prevalence ratios of AS against control were as follows: ischemic heart disease , peripheral vascular disease 1.6, and congestive heart failure 1.8. Cardiovascular risk factors were also increased: hyperlipidemia , hypertension , and type II diabetes . The estimated frequencies of aortic regurgitation and conduction disturbances vary considerably, ranging from 6 to 10 percent and 3 to 33 percent, respectively . AS patients do not need special testing for the presence of cardiovascular disease. Clinicians should be aware of the increased incidence of aortic regurgitation in AS and should periodically assess patients for symptoms and signs of aortic valve dysfunction. The indications for valvular replacement are no different from those with other causes of aortic regurgitation.
SOArthritis Care Res (Hoboken). 2011 Apr;63(4):557-63.
CONCLUSION: AS patients appear to be at higher risk of MI, which could be due to low HDL cholesterol levels or to systemic inflammation. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS.
Pulmonary disease - Many patients with AS have restrictions in chest expansion due to costovertebral rigidity [51,52]. A small percentage, varying from 1.3 to 15 percent in different reports, has apical pulmonary fibrosis by plain radiographs. The apical fibrosis is mostly asymptomatic and associated with a long duration of disease. High-resolution computed tomography abnormalities are much more common. These consist of mosaic pattern, subpleural nodules, and parenchymal bands and may be present even early in the disease [53,54]. When pulmonary function tests (PFTs) are compared between AS patients and matched controls, 18 percent of patients with AS, but none of the controls, show a restrictive pattern [55]. PFTs show a decrease in diffusion capacity and total lung capacity, while ventilatory capacity is generally preserved. Fibrotic disease and cigarette smoking may be risk factors for spontaneous pneumothorax, a complication that is otherwise rare in AS [56]. (See "Diseases of the chest wall", section on 'Ankylosing spondylitis'.) The cause of these abnormalities is unknown. Since bronchoalveolar lavage is generally unremarkable, there is probably no alveolitis [52]. On the other hand, transbronchial biopsies revealed interstitial fibrosis of variable degree in 5 out of 12 patients in one report, indicating that the radiologic appearance of apical fibrosis actually reflects a more generalized process [52].
Renal disease - In addition to analgesic abuse nephropathy, which is due to therapy, there are two other types of renal disease associated with AS: IgA nephropathy and secondary amyloidosis [57,58]. The development of IgA nephropathy is uncommon and should be suspected in patients with hematuria and proteinuria, with or without mild renal impairment. Secondary amyloidosis is also rare, occurring only in patients with longstanding active inflammation. Patients typically present with nephrotic syndrome and can progress to end-stage renal disease. Patients with longstanding disease should be screened with urinalysis for proteinuria. The diagnosis is established by renal, rectal, or fat pad biopsy. The prognosis is poor in those with renal failure. (See "Renal amyloidosis".)
Bowel mucosal ulcerations - Ileal and colonic mucosal ulcerations, which are almost always asymptomatic, can be detected by endoscopy in 50 to 60 percent of patients with AS [59]. A minority of those with endoscopic ulceration progress to clinically apparent inflammatory bowel disease (IBD, eg, ulcerative colitis or Crohn's disease). However, 5 to 10 percent of AS patients have concomitant IBD, and 4 to 10 percent of IBD patients have concomitant AS. A considerable proportion of IBD patients have asymptomatic sacroiliitis; the association between HLA-B27 and AS is weaker in the presence of established IBD [60].
