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Communications to the Editor |

Incidence of Pleuropulmonary Symptoms in Ankylosing Spondylitis FREE TO VIEW

C. Vaughn Strimlan, MD, FCCP
Author and Funding Information

Affiliations: South Hills Pulmonary Associates Pittsburgh, PA,  New York Methodist Hospital and Weill Medical College of Cornell University New York, NY

Correspondence to: C. Vaughn Strimlam, MD, FCCP, South Hills Pulmonary Associates, Roesch-Taylor Medical Building, 2100 Jane St, North-Suite 601, Pittsburgh, PA 15203



Chest. 2001;120(1):320-321. doi:10.1378/chest.120.1.320
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To the Editor:

I read with interest the Roentgenogram of the Month by Thai et al (December 2000).1This is an excellent example of a patient with ankylosing spondylitis and apical fibrobullous disease. In the discussion, the author states that “…the true incidence of fibrobullous lung disease… is not known, but reports range from 1 to 30%.” This statement is incorrect. Our previous comprehensive and thorough review of 2,080 patients clarified the incidence of apical fibrobullous disease.2 A total of 28 patients (an incidence of 1.3%) had pleuropulmonary manifestations of ankylosing spondylitis. This is the definitive report in the English-language literature. We clearly established an incidence figure between 1% and 2%. Hopefully, this figure has now been corrected and future reports will reflect the true incidence of this uncommon disorder.

References

Thai, D, Ratani, RS, Salama, S, et al (2000) Upper lobe fibrocavitary disease in a patient with back pain and stiffness.Chest118,1814-1816. [PubMed] [CrossRef]
 
Rosenow, E, Strimlan, CV, Muhm, JR, et al Pleuropulmonary manifestations of ankylosing spondylitis.Mayo Clin Proc1977;52,641-649. [PubMed]
 
To the Editor:

We welcome the comments of Dr. Strimlan in response to our Roentgenogram of the Month article (December 2000) regarding apical fibrocavitary disease in a patient with ankylosing spondylitis.1In their article2as well as in other review articles,34 a range of reported incidence of pleuropulmonary manifestations in ankylosing spondylitis quoted is 0 to 30%. However, in several original articles, the pathology was nonspecific fibrosis rather than apical fibrocavitary disease related to ankylosing spondylitis. In a review of 42 patients with ankylosing spondylitis, Chakera et al5found upper-lobe fibrosis in 6 patients (14.3%) in addition to focal pulmonary changes in 13 patients (30.9%). Interestingly, none of their patients developed cavities. Wolson and Rohwedder6found unexplained upper-zone fibrosis in 2 of the 52 patients with typical skeletal radiologic features of ankylosing spondylitis. In their follow-up, one patient developed a mycetoma in the area of fibrosis and the other patient showed no progression of fibrosis. Crompton et al7 found unexplained pleuropulmonary abnormalities in 14 of 225 patients (12%). Upper-lobe fibrosis was found in 12 of these 14 patients. In only one patient was there evidence of cavitation. We concur with Dr. Strimlan that apical fibrobullous disease is indeed an uncommon entity in patients with ankylosing spondylitis, as has been established in their large series.2

References
Thai, D, Ratani, RS, Salama, S, et al Upper lobe fibrocavitory disease in a patient with back pain and stiffness.Chest2000;118,1814-1816. [PubMed] [CrossRef]
 
Rosenow, EC, Strimlan, CV, Muhm, JR, et al Pleuropulmonary manifestations of ankylosing spondylitis.Mayo Clin Proc1977;52,641-649. [PubMed]
 
Lee-Chiong, TL Pulmonary manifestations of ankylosing spondylitis and relapsing polychondritis.Clin Chest Med1998;19,747-757. [PubMed]
 
Tanoue, LT Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjögren’s syndrome and relapsing polychondritis.J Thorac Imaging1992;7,62-77. [PubMed]
 
Chakera, TMH, Howarth, FH, Kendall, MJ, et al The chest radiograph in ankylosing spondylitis.Clin Radiol1975;26,455-460. [PubMed]
 
Wolson, AH, Rohwedder, JJ Upper lobe fibrosis in ankylosing spondylitis.Am J Roentgenol Radium Ther Nucl Med1975;124,466-471. [PubMed]
 
Crompton, GK, Cameron, SJ, Langlands, AO Pulmonary fibrosis, pulmonary tuberculosis, and ankylosing spondylitis.Br J Dis Chest1974;68,51-56. [PubMed]
 

Figures

Tables

References

Thai, D, Ratani, RS, Salama, S, et al (2000) Upper lobe fibrocavitary disease in a patient with back pain and stiffness.Chest118,1814-1816. [PubMed] [CrossRef]
 
Rosenow, E, Strimlan, CV, Muhm, JR, et al Pleuropulmonary manifestations of ankylosing spondylitis.Mayo Clin Proc1977;52,641-649. [PubMed]
 
Thai, D, Ratani, RS, Salama, S, et al Upper lobe fibrocavitory disease in a patient with back pain and stiffness.Chest2000;118,1814-1816. [PubMed] [CrossRef]
 
Rosenow, EC, Strimlan, CV, Muhm, JR, et al Pleuropulmonary manifestations of ankylosing spondylitis.Mayo Clin Proc1977;52,641-649. [PubMed]
 
Lee-Chiong, TL Pulmonary manifestations of ankylosing spondylitis and relapsing polychondritis.Clin Chest Med1998;19,747-757. [PubMed]
 
Tanoue, LT Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjögren’s syndrome and relapsing polychondritis.J Thorac Imaging1992;7,62-77. [PubMed]
 
Chakera, TMH, Howarth, FH, Kendall, MJ, et al The chest radiograph in ankylosing spondylitis.Clin Radiol1975;26,455-460. [PubMed]
 
Wolson, AH, Rohwedder, JJ Upper lobe fibrosis in ankylosing spondylitis.Am J Roentgenol Radium Ther Nucl Med1975;124,466-471. [PubMed]
 
Crompton, GK, Cameron, SJ, Langlands, AO Pulmonary fibrosis, pulmonary tuberculosis, and ankylosing spondylitis.Br J Dis Chest1974;68,51-56. [PubMed]
 
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