A 75-year-old woman was admitted to our department because of
backache and multiple
joint pain. Serum
C-reactive protein (CRP) level was 6.8 mg/dL, and serum
rheumatoid factor and anti-citrullinated
peptide antibody were negative. Magnetic resonance imaging (MRI) showed bone
edema and
synovitis of the sacroiliac joints. (18)Fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) showed increased uptakes in the bilateral elbow, shoulder, sternoclavicular, hip, and sacroiliac joints. In addition, increased uptakes were also observed in the bilateral cervical and subclavian arteries, and the thoracic aorta. Moreover,
inflammation of the vascular walls and an aneurism in the right subclavian artery were observed on MRI. The patient's HLA type was HLA-B48 and B60. According to the Assessment of Spondyloarthritis (ASAS) classification criteria, peripheral
spondyloarthropathy (SpA) was also diagnosed. Although the diagnostic criteria of Takayasu
aortitis or
giant cell aortitis were not fulfilled, we thought that active
aortitis was also involved, and high-dose
prednisolone was started. The patient's symptoms were diminished immediately, and CRP levels returned to normal. Although the etiology of the
aortitis was not certain, this is the first report of late-onset peripheral SpA with
aortitis, diagnosed by (18)FDG-PET and MRI. We recommended that it is important to evaluate the aortic involvement in late-onset SpA patients, when elevated systemic
inflammation is observed.