Ankylosing Spondylitis with HLA B27 Positive and Uveitis: Report of 2 Cases in Conakry (Guinea)

Abstract

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80 to 98% of cases are associated with HLA-B27. The most common extra-articular manifestation is anterior uveitis initially described in 1973. Objective: to report two cases of AS associated with uveitis in young African subjects. Case No. 1: A 20-year-old patient residing in Dakar, Guinea, followed up in ophthalmology department for anterior uveitis under dexamethasone eye drops for 2 months without favorable evolution, referred to rheumatology department for inflammatory lower back pain relieved by NSAIDs, bilateral buttock pain tilting and bilateral plantar talalgia, dodging lameness, dorsal kyphosis, lumbar stiffness (Schöber test at 5+4cm; normal at 5cm), positive sacroiliac maneuvers, BASFI: 5.67, BASDAI: 6. On para clinical investigations, HLA-B27 antigen was positive, pelvic scan showed stage 3 sacroiliitis on the left and 2 on the right according to Forestier’s classification. The diagnosis of non-radiographic primary axial AS HLA-B27 positive with peripheral involvement was made in accordance with the ASSAS criteria. He received 40mg of pyroxicam per day BD, 15mg of methotrexate per week, 15mg of folic acid per week with favorable evolution, BASFI: 2 BASDAI: 2.34, CRP: 14mg/l. Case No. 2: A 29-year-old Mauritanian patient, whose father was followed-up for reactive arthritis and his mother for primary axial AS. She consulted for inflammatory lower back pain VAS: 6/10, bilateral buttocks pain, bilateral plantar talalgia associated with redness of the left eye requiring an ophthalmology consult where the diagnosis of mixed uveitis was made. She had lumbar stiffness (hand to floor distance: 11cm), BASDAI: 6 BASFI: 4. Positive HLA-B27 antigen, pelvis CT scan revealed bilateral stage 4 sacroiliitis of Forestier’s classification, x-ray of the feet ....