Primary Biliary Cirrhosis and Ankylosing Spondylitis, A Rare Association

Primary biliary cirrhosis is an autoimmune liver disease, characterized by the progressive destruction of the small intrahepatic bile duct epithelial cells and the presence of antimithocondrial antibodies (AMA). Ankylosing spondilitis is a systemic, inflammatory, progressive disease, which usually affects the joints of the spine and the sacroiliac joints. The association of these two is very rare, in literature we found only one single study published in 1994, which describes the occurrence of primary biliary cirrhosis accompanying ankylosing spondylitis in amale patient. The aim of our study is to present the case of our patient, who had ankylosing spondylitis and has developed primary biliary cirrhosis. Our patient has ankylosing spondylitis with peripheral joint involvement, so according to the guidelines we initiated treatment with Sulfasalazine. We know from the literature about the hepatotoxicity of Sulfasalazine in some cases, so within each follow-up examination we monitored the liver function tests, and we also performed complete blood counts. The treatment of ankylosing spondylitis is challenging in this case due to the hepatotoxicity of the medications. Besides Sulfasalazine, our patient continued the treatment for primary biliary cirrhosis (ursodeoxycholic acid with hepatoprotective drugs in higher doses).