Thromboangiitis obliterans with inaugural rheumatic manifestations. A report of three cases

Thromboangiitis obliterans, or Buerger's disease, is a segmental occlusive inflammatory disorder of the small- and medium-sized arteries and veins seen in young adults and associated with cigarette smoking. The lesions are most marked in the distal limbs. We report three cases in which the first manifestations were rheumatic, consisting in polyarthritis in two cases and carpal tunnel syndrome in one. Rheumatic manifestations are infrequent and rarely inaugural in thromboangiitis obliterans, although they are probably underdiagnosed. Their pathogenesis is unclear but may involve autoimmunity. Heightened awareness of the possibility that rheumatic manifestations can inaugurate thromboangiitis obliterans may allow an earlier diagnosis of this disease, which may improve the functional prognosis. However, recovery can be achieved only if the patient stops smoking.