The aortic lesion of ankylosing spondylitis.

The occurrence of heart disease in rheumatoid arthritis and ankylosing spondylitis has been known for a considerable time, but its exact incidence and status has been the subject of much controversy, further confused by the North American inclusion of both diseases under one heading. In a survey of the subject in 1950, Bywaters distinguished three combinations: patients with rheumatoid arthritis and specific (rheumatoid) valve lesions; patients with both rheumatoid arthritis and, as a coincidence, rheumatic heart disease; and finally, patients with Jaccoud's syndrome (rheumatic heart disease and chronic post-rheumatic joint deformities). These three possibilities were also discussed by Thomas (1955) in relation to ankylosing spondylitis, and it was concluded that some of these patients were of the Jaccoud type. In his series of 12 cases with spondylitis and valvular disease, only two showed lone aortic disease, both with a previous history of rheumatic fever and thought to be rheumatic in origin; the remaining 10 presented mitral lesions predominantly. Only four cases of ankylosing spondylitis with necropsy were tabulated by Bywaters in 1950; one of them had mitral fibrosis without stenosis or regurgitation, and another calcified aortic valves. A larger series of cases has since been studied clinically (Wilkinson and Bywaters, 1958) and two patients have been found up to the present time presenting the aortic lesion described in "rheumatoid arthritis" (ankylosing spondylitis) by Bauer et al., 1951. As these appear to be the first described in this country, a detailed account, including necropsy data on one, is thought to be of interest.