Multidisciplinary management of a Spondyloarthritis presenting with bladder involvement as the initial clinical...

Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases that can present with diverse extra-articular manifestations. However, bladder involvement as the primary clinical presentation has not been previously reported.

We present a case report of a 55-year-old male with a 20-year history of recurrent left lower abdominal pain and lower urinary tract symptoms (LUTS). Despite multiple treatments for presumed chronic prostatitis and cystitis, symptoms persisted. Imaging revealed bladder wall alterations and inflammatory changes in bilateral sacroiliac joints. Laboratory tests showed positive HLA-B27 expression. Histopathological examination of bladder tissue demonstrated chronic inflammation with eosinophilic infiltration and vasculitis. These findings led to a diagnosis of SpA, despite the absence of typical musculoskeletal symptoms. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) inhibitors resulted in complete resolution of urological symptoms and normalization of bladder morphology. After one month of continuous management, the patient experienced significant relief from left lower abdominal pain (NRS 2-3) and LUTS. The patient reported complete alleviation of pain (NRS 0) and LUTS at the three-month follow-up. No recurrence was observed during a 1-year follow-up period.

This case highlights the potential for SpA to manifest primarily with urological symptoms, emphasizing the need for clinicians to consider systemic inflammatory conditions in cases of refractory LUTS. The successful diagnosis and management underscore the importance of interdisciplinary collaboration between urology and rheumatology.