Reumatizam, Vol. 70 No. 2, 2023.
Review article
https://doi.org/10.33004/reumatizam-70-2-4
First description of a female patient with advanced ankylosing spondylitis and polymyalgia rheumatica — A case report
Jure Aljinović
Daniela Šošo
*
Sanja Lovrić Kojundžić
Dušanka Martinović Kaliterna
Ivanka Marinović
* Corresponding author.
Abstract
This is the first case report regarding the co-existence of advanced ankylosing spondylitis (AS ) and polymyalgia rheumatica (PMR) in a female patient. So far, it was described in a case series report but exclusively in male patients. A 63-year-old female patient was diagnosed with PMR in 2015, according to EULAR /ACR provisional classification criteria. Glucocorticoid (GC) therapy was successful for all of the symptoms except for the long-lasting pain in the spine. In 2018, additional diagnostic tests were performed. HLA typing showed the presence of HLA -B*27, radiographs of sacroiliac joints showed grade III bilateral sacroiliitis and MRI described bilateral chronic sacroiliitis with partial ankylosis and subchondral sclerosis of the joints. AS was diagnosed in accordance with the modified New York criteria. Non-steroidal anti-inflammatory (NSAIDs) drugs were used with only small benefits and were discontinued in 2021 due to gastrointestinal complications (development of subileus). In 2021, an MRI of thoracic spine showed signs of anterior spondylitis at the Th5/Th6 level (Romanus lesion) and chronic Romanus lesion at the Th8/Th9 level. Adalimumab was introduced in October of 2021 and reduced symptoms by 60% after four months of treatment, significantly reduced abdominal pain and improved the overall quality of life. Adalimumab had no effect on PMR, but methotrexate and GK were effective in the treatment of PMR.
Keywords
ankylosing spondylitis, polymyalgia rheumatica, adalimumab, sacroiliitis
Hrčak ID:
320040
URI
Publication date:
8.8.2024.
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