Ankylosing Spondylitis

Ankylosing Spondylitis: Overview

Ankylosing spondylitis is an autoimmune disease which affects collagen structures, specifically the joints between the vertebrae of the spine.  The joints and ligaments that normally permit the spine to move become inflamed and stiff.  The bones of the spine may grow together, causing the spine to become rigid and inflexible.  Other joints such as the hips, shoulders, knees, or ankles also may become involved.

Incidence; Contributing Risk Factors

Symptoms of ankylosing spondylitis appear most frequently in young men between the ages of 16 and 35.  It is less common in women, whose symptoms are often milder and more difficult to diagnose.  About 5% of ankylosing spondylitis cases begin in childhood; boys are more likely to have it than girls.

The gene is present in 8% of white Americans and 2-3% of African Americans.  About 1% of the adult population has this condition and, as expected, the disease is three times more common in whites than in African Americans.

Heredity seems to play a role in determining who if affected: approximately one in five sufferers have a relative with the same disorder.  A gene called HLA-B27 that is present in over 90% of people with ankylosing spondylitis; of those who inherit the gene, 10-15% will fall victim to the condition.

Signs and Symptoms

When children develop ankylosing spondylitis, it usually begins in the hips, knees, bottoms of the heels or big toes and may later progress to involve the spine.

Diagnosis and Tests

Doctors usually base their diagnosis on symptoms and X-rays showing inflammation of the sacroiliac joints at the back of the pelvis.  If symptoms or X-rays suggest ankylosing spondylitis but the diagnosis is uncertain, your doctor may perform a blood test to check for the HLA-B27 gene.

Treatment and Prevention

By watching posture and body position and by doing exercises daily, an individual can control many of the effects of the disease.

Prognosis; Complications

Almost all sufferers can expect to lead normal and productive lives.  Despite the chronic nature of the illness, only a few people will become severely disabled; the management of pain and the control of inflammation can reduce the daily problems that may occur.

In extreme cases, the inflammation can cause the sacroiliac and vertebral bones to fuse or grow together.  When this occurs, the normal flexibility of the spine, including the neck, is lost and the whole spine becomes rigid.  Similarly, the bones in the chest may fuse, causing a loss of normal chest expansion when breathing.  The hips, shoulders, knees, or ankles also may become inflamed and painful and eventually lose their mobility.  The heels may become affected, making it uncomfortable to stand or walk on hard surfaces.

Ankylosing spondylitis is a systemic disease, meaning it can affect the entire body in some people.  It can cause fever, loss of appetite, and fatigue, and it can damage other organs besides the joints, such as the lungs, heart and eyes.  Inflammation can occur where the heart and aorta connect leading to possible enlargement of the aorta.  Most often, however, only the lower back is involved.

Conditions that suggest Ankylosing Spondylitis:

Organ Health

Iritis may suggest Ankylosing Spondylitis Iritis

The eye is the most common organ affected by ankylosing spondylitisIritis occurs from time to time in one-fourth of those with the condition.

Pain

Low Back Pain may suggest Ankylosing Spondylitis Low Back Pain

The inflammation occurring in cases of ankylosing spondylitis usually starts around the sacroiliac joints i.e.  the areas where the lower spine is joined to the pelvis.  The pain is worse during periods of rest or inactivity, often awakening patients in the middle of the night.  Symptoms typically lessen with movement and exercise.  Over a period of time, pain and stiffness may progress into the upper spine and even into the chest and neck.

Skin-Hair-Nails

Psoriasis may suggest Ankylosing Spondylitis Psoriasis

Ankylosing spondylitis may be associated with psoriasis.  A study published in [J Rheumatol 1998 Jan; 25[1]: pp120-4] found that out of 939 women with ankylosing spondylitis, 18% also had psoriasis.

Risk factors for Ankylosing Spondylitis:

Autoimmune

Ulcerative Colitis may increase risk of Ankylosing Spondylitis Ulcerative Colitis

See the link between Crohn's Disease and Ankylosing Spondylitis.

Crohns Disease may increase risk of Ankylosing Spondylitis Crohn's Disease

Bowel inflammation is somehow tied to the development of ankylosing spondylitis and this is the reason why people with Crohn's disease or ulcerative colitis are at increased risk of the illness.

Infections

Bacterial Dysbiosis may increase risk of Ankylosing Spondylitis Bacterial Dysbiosis

Intestinal overgrowth of an organism called Klebsiella plays a role in determining who is affected by ankylosing spondylitis and how severely.  Research by doctors at King's College has uncovered a tissue similarity between this organism and the spine.  In an autoimmune reaction to excessive amounts of Klebsiella, the immune system attacks the spine.  Controlling this dysbiosis by diet reduces symptoms of the disease.

Ankylosing Spondylitis suggests the following may be present:

Autoimmune

Infections

Ankylosing Spondylitis suggests Bacterial Dysbiosis Bacterial Dysbiosis

Intestinal overgrowth of an organism called Klebsiella plays a role in determining who is affected by ankylosing spondylitis and how severely.  Research by doctors at King's College has uncovered a tissue similarity between this organism and the spine.  In an autoimmune reaction to excessive amounts of Klebsiella, the immune system attacks the spine.  Controlling this dysbiosis by diet reduces symptoms of the disease.

Ankylosing Spondylitis can lead to:

Pain

Ankylosing Spondylitis usually leads to Low Back Pain Low Back Pain

The inflammation occurring in cases of ankylosing spondylitis usually starts around the sacroiliac joints i.e.  the areas where the lower spine is joined to the pelvis.  The pain is worse during periods of rest or inactivity, often awakening patients in the middle of the night.  Symptoms typically lessen with movement and exercise.  Over a period of time, pain and stiffness may progress into the upper spine and even into the chest and neck.

Recommendations for Ankylosing Spondylitis:

Botanical, Chinese

Lei Gong Teng is highly recommended for Ankylosing Spondylitis Lei Gong Teng

Ankylosing spondylitis responded to TP (polyglycoside extract of Tripterygium wilfordii Hook F), sulfasalazine and methotrexate with effectiveness rates of 85%, 60% and 60% respectively after 6 months of treatment.  In most cases treated with TP, alleviation was noted in symptoms of the spine and joints 2 weeks after starting the extract, and improvement in pain and swelling of joints and backache was observed 2 weeks later.  [Chin Med J (Taipei) 1996; 57: S35]

Diet

Grain-free Diet is highly recommended for Ankylosing Spondylitis Grain-free Diet

In an attempt to confirm a connection between Ankylosing Spondylitis (AS) and Klebsiella, doctors at Kings College introduced a low starch diet to AS patients, along with medication to control symptoms.  Klebsiella thrives on a diet rich in starch.  Without starchy carbohydrates such as rice, potatoes and flour products, the number of Klebsiella are reduced in the gut and, subsequently, so is the production of antibodies to the bacteria that cause the inflammation.  Patients were instructed to cut out bread, pasta, cereals of all sorts, rice and potatoes as well as sugary foods.  They were unrestricted in eating vegetables, fruit, eggs, cheese, fish and meat. 

Over 200 patients have so far been through this program with the claim being made that the majority have had their disease process halted.  One patient is quoted as saying "Once I stuck to the diet religiously, I noted a real improvement after six months or so.  Movement became easier and the lethargy and depression lifted.  The best way I can describe it is that after years of pain and stiffness I suddenly feel 'well-oiled'."

KEY

Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of
Weak or unproven link:
may be a sign or symptom of; may suggest; may increase risk of
Strong or generally accepted link: is often a sign or symptom of
Strong or generally accepted link:
is often a sign or symptom of
Definite or direct link: suggests; usually leads to
Definite or direct link:
suggests; usually leads to
Weakly counter-indicative: may contraindicate
Weakly counter-indicative:
may contraindicate
Very useful: is highly recommended for
Very useful:
is highly recommended for