Bloqueio cardíaco completo em espondilite anquilosante

Abstract

Ankylosing spondylitis (AS) is a chronic rheumatic disease of young men that affects mainly the axial skeleton and is associated with HLA-B27 in 90% of the cases. Incidence of cardiovascular involvement in AS ranges between 10%-30%; conduction disturbances have been described in 1%-9% of the patients with AS. The majority of the series show a relationship with longstanding disease. To our knowledge, this is the fi rst report of complete heart block in early AS.

Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients

“…Firstly, patients suffering from different forms of SpA were included, while most other studies are limited to patients with AS. ( 3 , 4 , 7 , 10 ) Spondyloarthritis is associated with higher prevalence of HLA-B27 positivity; ( 3 ) therefore lower prevalence of this histocompatibility antigen in this sample may explain the lack of associations with electrocardiographic changes reported by other authors. A second explanation, also related to lower prevalence of HLA-B27 positivity, is the fact that this study was based on a Brazilian population.…”

“…Two anedoctal theories may explain conduction disorders in the context of this study: atrioventricular node abnormalities and intraventricular septal inflammation. ( 3 ) Endarteritis of small vessels supplying the aortic valve and atrioventricular node and resulting obliteration by inflammatory process (very similar to that observed in joints) has been described. ( 4 ) Had electrocardiographic changes resulted from the inflammatory process, it would be reasonable to assume such changes would be reverted by anti-TNF-α drugs.…”

“…( 1 , 2 ) Major complaints associated with SpA are of musculoskeletal origin; however, several extra-articular manifestations have been reported, including cardiac conditions such as aortitis, aortic insufficiency, conduction disorders and atrioventricular blocks, ( 1 ) which are thought to affect approximately 10% of patients. Cardiac involvement is often subclinical, associated with longstanding disease ( 1 , 3 ) and unrelated to articular disease activity. ( 1 ) Pacemaker implantation and valve replacement may be required in severe cases.…”

“…The B27 human leucocyte antigen (HLA) is strongly associated with SpA (particularly AS) and is found in up to 90% of cases. ( 3 ) Third-degree AVBs of unknown cause requiring pacemaker implantation in young males are thought to be associated with HLA-B27, ( 1 ) and 15 to 20% of individuals with permanent pacemaker are positive for this antigen. ( 3 ) However, failure to detect associations between the HLA-B27 positivity and conduction abnormalities Forsblad-d’Elia et al ( 4 ) raised controversies over this matter.…”