Rheumatic manifestations in patients with thromboangiitis obliterans (Buerger's disease).

OBJECTIVE To evaluate articular involvement in a large cohort of patients with thromboangiitis obliterans (TAO). METHODS A retrospective chart review of all patients with TAO admitted to our rheumatology or vascular medicine departments between 1975 and 1995 was undertaken. Patients with a history of osteoarticular involvement were further investigated. This evaluation entailed taking a detailed rheumatologic and musculoskeletal history and physical examination. Laboratory tests and osteoarticular radiographs were obtained. RESULTS Initial rheumatic manifestations were observed in 11 (12.5%) (7 male/4 female) of 83 (71 male/12 female) patients with TAO. Eight patients presented recurrent episodes of arthralgia, which preceded the diagnosis of TAO by 2 to 13 years (median 10 years). The episodes were monoarticular, acute, transient, and migratory, affected large joints with local inflammatory signs, and were nonerosive. The initial diagnosis often referred to a loco-regional or periarticular problem that tended to recur. There was permanent disappearance of these prodromal rheumatic features with the appearance of ischemic features. Two patients had HLA-B27+ undifferentiated spondyloarthropathies and one presented oligoarthritis. CONCLUSION TAO should be considered in patients presenting intermittent rheumatism. The key symptoms and signs of the disease should be monitored during the followup period because the first occlusive features may appear more than 10 years later. Thromboangiitis manifestations can thus be similar to systemic vasculitis and connective tissue disease. If the patient is a young adult smoker, particularly a young man with diminished or absent distal pulses, a diagnosis of TAO should be considered.