aortic dissection associated with AS

[hankstar]

Dear Doctor,

     I have ankylosing spondylitis that is associated with severe attacks of costochondritis,I also suffer from fibromyalgia as a result of ankylosing spondylitis, it is a terrible illness, it literally makes you feels like you are having a heart attack for days on end with the severity of pain, on a scale of 1-10 , I rate it an 8-9. It is incapacitating when it strikes usually in spasms lasting less than a one minute or sometimes alittle more than a minute and recurring throughtout the hour or days. Sometimes I am left with a constant pain that is more of a dull ache and then when I take a deep breath it is really sharp.
     I know that 2-3% of person with AS the aortic valve can be affected, but usually does not progress to the point where surgery would be necessary.
     My biggest fear is an aortic dissection, my only question is. Are you aware of anyone that suffered an aortic dissection as a result of chronic inflammation from ankylosing spondylistis?
     Should have included this yesterday, but I'm stricken with pain today. I will be seeing my internist on Tuesday next week as he is visting from Canada and have an chest x-ray done. When I went to the hospital last time the pain struck, they refuse to do an chest x-ray even though I insisted, just did an ECG and cardiac enzymes.

Thanks in advance,
           Hank.

[jan]

Hi Hankstar,

I don't have AK, but I do have costochondritis.  The costo was terrificly relieved when I rec'd 3 cortisone shots in my ribs and 3 in my chest. Now I just get a mild "attack" and it doesn't last long. (I don't do anything that will strain that area, either).  If I ever get to that point again I will go back to my rheum and get more shots.  Are you allowed to get cortisone shots?  If so, maybe you should consider them.

By the way there is a good chat in Yahoo Users chatrooms, it's called Chronic Illness Support (the name chgs depending on who opens the room).  There are many with fibro there and a few come in who have AK.  The group is primarily, but not limited by any means to fibro, cfs, lupus, MS, arthritis, you get the idea.  

[Cleveland Clinic]

Sorry, I jumped thoughts.  I was thinking if these symptoms have been coming and going, and you've had xrays, cts, echos to evaluate for aortic disease, then it is somewhat unlikely that this is active vasculitis/aortitis or dissection.

I'm not sure who you follow for your AS, but it might be worth asking your rhematologist for their opinion or experience with
vasculitis in the setting of AS.

good luck.

[Cleveland Clinic]

Hank,

The vasculitis that can sometimes be associated with Ankylosing Spondylytis has been associated with aortic aneurysms in some case reports. Also, there is a case description of aortic dissection. However, all of these are cited as case reports and seem fairly rare. I usually do not think of vasculitis as the primary symptom of ankylosing spondylitis.

From my experience, aortic dissection pain is generally pretty distinctive.   Most describe it as sudden onset, tearing or ripping, that goes through to the back. Generally, the pain is at its absolute worst at the time of onset.  If you've experience the same sensation over and over then it's probably  

Even an x-ray isn't perfect for detecting an dissection or anurysm, gennerally the gold standard is other imaging such as CT scans, TEE or MRI.