Ankylosing spondylitis

Ankylosing spondylitis, also known as Morbus Bechterew, evil Strumpell-Marie-Bechterew, rheumatoid spondylitis, ankylosing spondylitis is a chronic autoimmune disease with rheumatic pain and gradual hardening of the joints. Seronegative because the blood test result RF (rheumatoid factor) is negative, unlike rheumatoid arthritis when it is positive.

The espondiloatropatias include reactive arthritis, psoriatic arthritis, and inflammatory bowel disease, including ulcerative colitis and Crohn’s disease. Primarily, it affects the spine, ligaments, inflammation called enthesitis of the skeletal muscle, especially in the cervical, lumbar and sacroiliac joints or iliosacral areas but it may also affect other joints like the hip, knee, shoulder and the Achilles’ heel.

During the course of the disease there may also appear on the iris of the eye, inflammation (iritis) in the uvea (uveitis) causing migraines and photophobia. It may also affect other organs like the kidneys and lungs.

Description

According to a study of blood donors in the city of Berlin, it is estimated that approximately 1.9% of the German population suffers from this disease. It is not known if this figure can be projected to the rest of the world’s population, but the probability is quite high. In many cases the disease has very mild symptoms, making it very difficult to diagnose

.Formerly it was believed that the disease occurred three times as often in men than in women. This error occurs because the disease presents with symptoms milder in women than in men, at least in regard to ossification or hardening of the spine.

The first symptoms usually appear between the age of 20 and 25 years old and only 5% of cases after age 40. The appearance of the disease is closely related to the HLA-B27, an antigen which appears to play an important role in the immune system functions. For this reason it is assumed that this is a bad inheritance.

While the HLA-B27 gene is best known in this context, one can not rule out the possibility that other genes are also involved in the inheritance of the disease. Some of the pioneers in the investigation of ankylosing spondylitis were Wladimir Bechterew, Pierre Marie, Adolf von Andre and Strumpell Leri.

Diagnosis

There are deformations in the cervical spine in advanced cases of ankylosing spondylitis.

Since the onset of the first symptoms, definitive diagnosis usually pass, according to the German association of Morbus Bechterew, between 5 and 7 years, and in some isolated cases up to 15 years, which can be avoided by systematic studies. Specific analysis is recommended when they have suffered from back pain for longer than three months before reaching 45 years of age. The characteristic symptoms are:

Acute back pain at dawn
Morning stiffness of at least one hour
Symptoms diminish with movement

Motor limitations typical of the disease can be measured quite accurately with simple methods (method of Schober, Ott method, measuring the distance from chin to sternum, measuring the distance between the back of the head and the wall and measuring the gradual reduction in lung volume). A reliable diagnosis can be obtained with the help of a study of the pelvis, particularly the sacroiliac joint using magnetic resonance. The rheumatoid factor is negative in 100% of cases.

This is what distinguishes this disease from rheumatoid arthritis. 90% of the patients were HLA-B27 antigen positive. Since this gene appears in nearly 9% of the world’s population, their detection is not enough to establish a reliable diagnosis. Inflammatory markers CRP and ESR showed 50% of inflammatory activity in some patients. This was not conclusive as it was the presence of subchondral sclerosis, or inflammation in the sacroiliac joints and pelvis.

Treatment

The treatment of ankylosing spondylitis plays a key role in gymnastics and physical therapy to maintain joint mobility and prevent gradual deforming of the spine (kyphosis), although exercise may be somewhat painful for the patient concerned. But most important is to visit a licensed chiropractor and this can be much more productive than just physiotherapy.

Especially recommended are extension exercises such as Yoga or Pilates. The basic treatment is sulfasalazine or sulfapyridine, immunomodulating drugs that reduce inflammation in joints. Since 2003 the so-called “biological” drug Enbrel (Amgen, Etanercept, Infliximab), a preparation of the family of TNF-alpha blockers (TNF = tumor necrosis factor) has reduced the inflammatory processes.

Different studies show that Adalimumab, the first fully human monoclonal antibody, may decrease the signs and symptoms, inducing major clinical response in patients.

Adalimumab binds specifically to TNF, the tumor necrosis factor alpha but not lymphotoxin (TNF-beta)) and neutralizes the biological function of this by blocking its interaction with p55 and p75 receptors for TNF in the cell surface.

These drugs at present are very expensive, but they have obtained very good results, although there are still no long-term studies to ensure their safe use. Prior to its appearance nonsteroidal antiinflammatory drugs (NSAIDs) such as indomethacin, sulfasalazine and methotrexate were used for reducing the pain and to control inflammation.

There are also studies that referred to treatment with pamidronate and thalidomide. In very advanced cases there is also a surgical solution, in which the vertebrae are fractured and re-clamped in the proper position with metal plates. This operation is complicated with a little risk, but can greatly improve the quality of life of patients.

No starch diet

The research team led by immunologist Alan Ebringen London could identify the bacteria Klebsiella pneumoniae as one of the main predisposing immune-reactions. This bacterium, which resides in the large intestine and has a structure very similar to the HLA-B27 antigen, feeds mainly on starch polysaccharides and which, by its complex structure can not be completely digested in the stomach or small intestine.

Ebringen is able to demonstrate the removal of the starch of nutrition and achieve a considerable reduction in the population of Klebsiella in the body. While this does not cure the disease, the decreased immune system’s reaction is to such an extent, that almost all the symptoms disappear soon after the nutritional plan is changed.

Another perspective which is similar is by Jean Seignalet, an immunologist, biologist nutritionist and author of ‘French origin Food, third medicine’, which argues that many autoimmune diseases are “activated” due to the current power that would generate intestinal flora of putrefaction and fermentation, making certain bacteria can multiply at an alarming rate and activating certain diseases of the genetic group.

He proposes a scheme for removing toxins from the body quite radically, which prohibits the consumption of cereals (and thus eliminating much of the starches), dairy (because lactose is a sugar which is very difficult to digest), refined oils and advice to eat common probiotics and starter cultures.

Unfortunately, the studies are little known outside their respective countries and only patients suffering from these diseases often report about them.