Pulmonary involvement in ankylosing spondylitis

Abstract

Background. Ankylosing spondylitis (AS) is chronic inflammatory disease, mostly affecting the axial skeleton and peripheral joints. Extra-articular manifestations: involvement of the eyes, lungs, heart, and kidneys are noted. Respiratory problems have been seen in up to 30% of AS patients. Objective of the study. To determine the impact of pulmonary involvement in AS. Material and methods. Through the PubMed, NCBI, NIH databases Rheum and Science Direct 50 publications were selected. Result. Pneumopathy in AS begins in the early stages of the disease and worsens over time. Clinical picture consists of progressive dyspnea, cough, sometimes hemoptysis sputum, marked fatigability. The most frequent pleuropulmonary symptoms are upper lobe fibrosis, mycetoma formation, and pleural thickening. The development of pulmonary apical fibrosis takes around 20 years, and advances gradually. Early pulmonary apical fibrocystic illness can be asymmetrical, but most instances have bilateral apical fibrobullous lesions. Many of cases worsen over time, resulting in nodule coalescence, cyst and cavity formation, fibrosis, and bronchiectasis. High-resolution computed tomography (HRCT) of the lungs shows that 40–90% of patients have a variety of pleuro-parenchymal symptoms, including ground glass attenuation (11.2%), bronchiectasis (10,8%), emphysema (18%), upper lobe fibrosis (7%), and unspecified interstitial abnormalities (33%). The higher lobe cysts and cavities, secondary fungal and mycobacterial infections, Aspergillus fumigatus was isolated. Fusion of the costovertebral joints, ankylosis of the thoracic spine/anterior chest wall involvement result in a restricted ventilatory impairment. Conclusions. Pulmonary parenchymal disease is typically asymptomatic and progressive in AS. Patients need regularly examinations even if their complaints have subsided.