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Rarity of nephropathy in ankylosing spondylitis.

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1510
condition, who presented with acute attacks (average 9.3)
the year before the study. Each patient was treated exclusively with oral colchicine (1 mg daily) for 1 year. The result
was an evident decline of acute attacks in these patients
(average 2.4, P < 0.05). This suggests that colchicine can
have a prophylactic effect in the acute inflammation of
pseudogout.
Tomas Gonzalez
Marian Gantes
Hospital General y Clinic0 de Tenerife
Facultud de Medicinu de La Laguna
Cunary Islands, Spain
Thrombocytopenia in Sjogren’s syndrome
To the Editor:
Recently we reported a patient with Sjogren’s syndrome, thrombocytopenia, and paraproteinemia, and we
stressed the rarity of thrombocytopenia in this syndrome ( I ) .
We now report another patient with a similar disease course.
A 45-year-old woman was referred to us because of
thrombocytopenia found on routine examination. She had a
history of back pain some years earlier but had been treated
only with analgesics.
On admission, no liver, spleen, or lymph nodes were
palpable. Laboratory data were as follows: erythrocyte
sedimentation rate (ESR) 15 mmihour (Westergren); hemoglobin 13.7 gm/liter; hematocrit 41%; white blood cell count
(WBC) 5,400 x IO‘lliter, with a normal differential count;
platelet count 70 x lO’/Iiter. Results of blood chemistry
tests, urinalysis, and serologic tests (including lupus erythematosus preparation, complement levels, and antinuclear
factor) were within normal limits. Cryoglobulin was not
found; serum protein electrophoresis showed a mild heterogenic hypergammaglobulinemia, but no paraprotein. Because the patient complained of dryness in the mouth, a
Schirmer’s test was performed; the results showed a partial
positive reaction. Bone marrow examination showed an
increase in immature megakaryocytes and mild lymphoplasmocytosis; because of this finding, chronic immune thrombocytopenic purpura could not be excluded.
No treatment was given to the patient, but her
progress was followed in the outpatient clinic. One year after
the first examination, dryness in the mouth and eyes was
more severe. Results of the laboratory tests were as follows:
ESR 40 mm/hour; hemoglobin 12.7 gm/liter; hematocrit 37%;
WBC 5,200 x 106/literwith normal differential count; platelets 70 X 109/liter.Results of blood chemistry tests (including
kidney and liver tests) and protein studies remained within
normal limits. Leukocyte and thromboagglutinin test results
were negative, as were the results of direct immunofluorescence tests for platelet IgG. C3 was 85 mgiml (earlier it had
been 123 mg/ml); C4 was 15 mg/ml (earlier it had been 24.5
mg/ml); and total hemolytic activity was 25% of normal. The
Schirmer test results were positive for both eyes (earlier they
had been positive for only one eye).
LETTERS
To confirm the diagnosis of Sjogren’s syndrome, we
performed a labial biopsy. No immunoglobulins were detected by direct immunofluorescence on frozen sections. The
histology showed foci of lymphocytic infiltrate in the salivary glands, which is consistent with Sjogren’s syndrome
grade 4 (2).
In summary, thrombocytopenia can occur in Sjogren’s syndrome (1,3) and, as in this patient, can even
precede the complete picture of the syndrome.
Alain Berrebi, MD
Motti Shtalrid, MD
Monica Talmor, MSc
Eljakim Vorst, BSc
Kaplan Hospital
Rehovot, Israel
1. Berrebi A, Schattner A: Sjogren’s syndrome with IgG kappa
paraprotein and thrombocytopenia. Arthritis Rheum 24: 14511452, 1981
2. Chisholm DM, Mason DK: Labial salivary gland biopsy in
Sjogren’s disease. J Clin Pathol 2 I :656-660. 1968
3. Whaley K, Webb J , McAvoy BA: Sjiigren’s syndrome. 11.
Clinical associations and immunological phenomena. Q J Med
42:513-548, 1973
Rarity of nephropathy in ankylosing spondylitis
To the Editor:
In a recent article, Jennette et al (1) suggested that
IgA nephropathy may be associated with seronegative spondylarthropathies. They questioned whether this apparent
link could be a general one demonstrable at low frequency or
a local phenomenon caused by a regional environmental
stimulus. The former possibility, as they suggest, seems
unlikely since there have been several studies performed
that have looked repeatedly at renal function in ankylosing
spondylitis.
In one such investigation, a pharmacologic study (21,
30 patients with ankylosing spondylitis were seen on nine
occasions during a 6-month period. In a more specific
investigation of renal glomerular function (3), a different
series of 38 consecutive patients was evaluated with urinalysis and formal study of glomerular function. In none of these
68 patients was there an episode of microscopic hematuria.
If a nephropathy occurs in ankylosing spondylitis, it appears
to be extraordinarily rare.
Andrei Calin, MD, MRCP
Stunford University Medical Center
Stanford, C A
1. Jennette JC, Ferguson AL, Moore MA, Freeman DG: IgA
nephropathy associated with seronegative spondylarthropathies.
Arthritis Rheum 25: 144-149, 1982
2. Calin A , Britton M: Sulindac in ankylosing spondylitis: double
blind evaluation of sulindac and indomethacin. JAMA 242: 18851886, 1979
3. Calin A: Renal glomerular function in ankylosing spondylitis.
Scand J Rheumatol 4:241-242, 1975
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nephropathy, ankylosis, spondylitis, rarity
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