Ankylosing spondylitis

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This is the best worked out example of molecular mimicry, whereby the immune system gets confused. The gut has bacteria in it which the immune system may make antibodies to. Sometimes the gut has bacteria present called Klebsiella.

It just so happens that if you have a particular tissue type (HLA B27), then the microscopical shape of the spinal ligaments is sufficiently similar to Klebsiella to allow cross-reaction. Antibodies meant for Klebsiella start to stick to spinal ligaments and cause inflammation. Inflammation of the ligaments of the spine cause the symptoms of ankylosing spondylitis (AS).

Clinical picture

  • Men sufferers outnumber women by 10 to 1
  • Symptoms often start in late teenage years or early 20s
  • It often runs in families down the male line
  • It often takes years between the onset of symptoms and diagnosis
  • It starts with stiffness in the lower back, worse in the morning and improving as the day progresses.
  • X-ray changes take several years to develop
  • If the back is not exercised, the ligaments calcify and become solid, leaving the patient with a completely rigid spine.
  • The pain is lessened when the patient bends his back forward, so he tends to hold himself like this. As a result the spine solidifies and he eventually gets stuck in a bent position.

Diagnosis

  • Suspect AS from the above history
  • Do tissue typing for HLA B27
  • Do tests for inflammation
  • Early in the illness, X-ray may be normal
  • Late in the illness, X-ray of the back shows up calcification of ligaments called "bamboo spine"
  • MRI scan of the back

Treatment

1. See Arthritis.

2. It is especially important that the spine is put through its full range of movement every day to prevent it seizing up solid. Hydrotherapy is particularly helpful. The patient must hold himself straight and not allow himself to become bent forwards. There are some good exercises on NATIONAL ANKYLOSING SPONDYLITIS SOCIETY.

3. Diet - the idea here is to starve out the bacteria in the gut by doing a low starch diet. See Fermentation in the gut and CFS.

4. Anti-inflammatory drugs (NSAIs). I do not like using pain killers for arthritis because pain is Nature's way of telling you to rest the joint. However, the inflammation in AS is a useless, unnecessary inflammation and NSAIs could be used at night if the pain is preventing sleep. See Inflammation - all interventions to damp down inflammation will help.

The disease can be monitored by doing tests of inflammation.

Complications

25% get iritis - an inflammation in the eye causing pain (sometimes this can be diagnosed by looking in the mirror for a "pool" of whiteness in the lower half of the iris). This needs an urgent consultant opinion. Rarely the heart is involved with conduction defects and valve problems.

Genetic effects

Most patients with AS are HLA B27 positive. This means 50% of their children will also be positive and they will have a 33% chance of developing AS.

Related Tests

Related Articles

References


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