Chronic otitis media: a new extra-articular manifestation in ankylosing spondylitis?

Following a study reporting a fourfold increase in the occurrence of chronic otitis media in patients with ankylosing spondylitis, this prospective study examines this association with respect to severity, duration of disease, and acute phase in ankylosing spondylitis. Forty two consecutive patients with classical ankylosing spondylitis seen at the rheumatology clinic of a teaching hospital where the features of ankylosing spondylitis were recorded had an otological examination by an otolaryngologist. The occurrence of chronic otitis media (all categories) was 12/42 (29%). The acute phase serum markers (C reactive protein and IgG) were increased in patients with active or inactive chronic otitis media. Extra-articular manifestations were significantly more common in the chronic otitis media group than in those with no history of chronic otitis media. The results of this study suggest that chronic otitis media may be another extra-articular manifestation of ankylosing spondylitis. Alternative explanations, however, include similar aetiological factors for the two conditions or a previously unrecognised increased occurrence of HLA-B27 in patients with chronic otitis media.