Thromboangiitis obliterans or Buerger's disease: challenges for the rheumatologist

Abstract

Thromboangiitis obliterans (Buerger's disease)--a type of vasculitis in young, mostly male subjects--remains strangely linked to smoking, which determines its occurrence, progression and prognosis by currently unknown mechanisms. It affects the small and medium-sized arteries and veins of the limbs. Despite the usual absence of systemic signs and symptoms, initially intermittent arthritis, even if not observed in all cases, confer on this disease the status of a systemic vasculitis. Diagnosis requires the elimination of many other diseases. The severity of the disease lies in the need for amputation in more than a quarter of all patients. Complete cessation of smoking remains the cornerstone of therapy. Local care is the second essential element of treatment. Prostacycline analogues can be used to help the patient through critical ischaemia. Blockade with antagonists of cannabinoid or endothelin receptors and the use of gene- or cell-based therapy to induce therapeutic angiogenesis have opened up new possibilities for treatment.

Vasculitides as a rare cause of intermittent claudication

“…It predominantly occurs in young males with a strong link to history of past or current tobacco consumption, only less than 5 % are nonsmokers (25). Clinical picture of TAO is quite different from either atherosclerosis or other vasculitides posting this disease into a specifi c category of vasculitides (24).…”

“…In one study lead by Stvrtinova and her colleagues intermittent claudication was a symptom present in almost 73 % of patients with TAO (26). Other signs and symptoms of TAO include superfi cial thrombophlebitis that could be migratory and recurrent, numbness and tingling of the digits, paresthesia, Raynaud´s phenomenon (24,25,27). Systemic signs and symptoms are often rare, except for rheumatic manifestations.…”

“…Diagnosis of TAO is rendered diffi cult for the lack of specifi c subjective symptoms, objective signs, radiological and laboratory fi ndings, the specifi city of histopathological evidence as well as the lack of internationally accepted and well defi ned diagnostic criteria (25).…”

Buerger's Disease Manifesting Nodular Erythema with Livedo Reticularis

“…Small-vessel involvement has been shown to complicate BD in one clinical re-port (6). Implantation of bone marrow stem cells or omental transplantation may prevent progressive necrosis in BD (8)(9)(10), and early diagnosis using angiography is important if this disease is suspected as a cause of nodular erythema and livedo reticularis.…”

Coexistence of axial spondyloarthritis and thromboangiitis obliterans in a young woman

“…Clinically TAO is characterized by coldness and rest pain in the distal extremities, due to ischemic manifestations which might also lead to Raynaud's phenomenon, acrocyanosis, and necrosis of finger tips (6). To date, the cornerstone of management is smoking cessation, whereas other treatments aimed at improving the blood flow and dilating the blood vessels are less effective (7). We herein describe the case of a female patient presenting with an uncommon coexistence of axial spondyloarthritis (SpA) and TAO.…”