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.
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.
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.
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.
By watching posture and body position and by doing exercises daily, an individual can control many of the effects of the disease.
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.
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.
See the link between Crohn's Disease and Ankylosing Spondylitis.
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.
Ankylosing spondylitis may be associated with psoriasis. A study published found that out of 939 women with ankylosing spondylitis, 18% also had psoriasis. [J Rheumatol 1998 Jan; 25(1): pp120-4]
The eye is the most common organ affected by ankylosing spondylitis. Iritis occurs from time to time in one-fourth of those with the condition.
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.
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]
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.
The majority of over 200 patients who went through this program are claimed to 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'."
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