Ankylosing Spondylitis

Ankylosing spondylitis (AS) 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. 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.

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.

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

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.

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.

Although Reiter’s Syndrome is not mentioned on Ebringer’s site, it is his opinion that, after a couple of years, RS becomes AS, as the same mechanism is involved.

 


Signs, symptoms & indicators of Ankylosing Spondylitis

Symptoms - Food - General  

Weak appetite



Symptoms - General  

Constant fatigue



Symptoms - Metabolic  

Not having a fever or having a slight/having a moderate/having a high fever




Conditions that suggest Ankylosing Spondylitis

Musculo-Skeletal  


Organ Health  

Iritis

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.



Pain  

Low Back Pain / Problems

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

Ankylosing spondylitis may be associated with psoriasis.




Risk factors for Ankylosing Spondylitis

Autoimmune  

Ulcerative Colitis

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



Infections  


 

Dysbiosis, Bacterial

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

Infections  

Dysbiosis, Bacterial

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  

Low Back Pain / Problems

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

Animal-based  

Cetyl-myristoleate

Case History: Rick took an aggressive treatment approach for ankylosing spondylitis. His protocol included cetyl-myristoleate, vitamin C, curcumin, lipoic acid, and a low-calorie, high-protein diet. He wrote: “The overall effect was extremely positive — complete remission of all symptoms and indications.” He added that he experienced improvement in five days, and continued toward maximum improvement of 90% in just 10 days. Although many patients have remained symptom-free, some need additional treatments periodically.



Botanical, Chinese  

Lei Gong Teng (Tripterygium wilfordii Hook F)

Ankylosing spondylitis responded to TP (polyglycoside extract of Tripterygium wilfordii Hook F), sulfasalazine and methotrexate with effective 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 / Low Starch 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’.”



Drug  

Conventional Drugs / Information

Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into two products: 5-aminosalicylic acid (5ASA), and sulfapyridine. There is some controversy as to which of these two products are responsible for the activity of azulfidine. Whereas it is known that 5ASA has therapeutic benefit, it is not clear whether sulfapyridine adds any further benefit. In the colon, the products created by the breakdown of sulfasalazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulfasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immune-suppressant effect as well. Following oral administration, 33% of the sulfasalazine is absorbed, all of the sulfapyridine is absorbed, and about 33% of the 5ASA is absorbed. Sulfasalazine was approved by the FDA in 1950.

Through a long line of firsts in the biotechnology industry, the history of REMICADE includes 15 FDA indications spanning across inflammatory diseases that include Crohn’s disease (adult and pediatric), ulcerative colitis, rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis and psoriasis. (2007)



Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
May do some good
Highly recommended

Glossary

Spondylitis

Inflammation of one or more vertebrae.

Autoimmune Disease

One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Collagen

The primary protein within white fibers of connective tissue and the organic substance found in tendons, ligaments, cartilage, skin, teeth and bone.

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Psoriasis

An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.

Crohn's Disease

Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Immune System

A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

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