Ankylosing Spondylitis and Axial Spondyloarthritis

Ankylosing Spondylitis and Axial SpondyloarthritisTo the Editor: In their review article, Taurog and colleagues (June 30 issue) 1 offer a detailed update about spondyloarthritis.Although the article deals with the main features of spondyloarthritis, cardiovascular manifestations are not described.In addition to hypertension and the metabolic syndrome (well-described coexisting conditions in these patients even in the absence of clear clinical findings), 2 cardiac-conduction disease and structural heart disease have also been described in this population.Conduction abnormalities may range from first-grade atrioventricular block or the presence of an inadequate escape rhythm to complete heart block causing Stokes-Adams attacks that require urgent hospitalization.3 Among structural abnormalities, aortic involvement is a potentially life-threatening complication.It can occur in the early stage or, more commonly, in the late phases of the disease.Aortitis characteristically involves the aortic root and the ascending aorta, leading to valvular insufficiency.The seriousness is highly variable, ranging from acute and rapidly worsening aortic insufficiency to chronic and hemodynamically irrelevant fibrosis.4 Moreover, it can also lead to cardiac-conduction disease because the aortic fibrosis can extend to the interventricular septum and contribute to the fibrosis of the inflammatory lesions.