ANKYLOSING SPONDYLITIS
Report #7209
When a person has severe lower back pain, doctors often order blood tests for arthritis and a genetic marker called HLAB27. Positive tests often lead to a diagnosis of ankylosing spondylitis, an arthritis of the spine.
Most doctors think that ankylosing spondylitis is an autoimmune disease in which a person's immunity is so stupid that it attacks and destroys the joints in his back, rather than just doing its job of protecting a person from infection. However, several recent papers show that ankylosing spondylitis may actually be caused by infection. One recent paper shows that people who have this condition are more likely to have genital infections with mycoplasma, chlamydia and ureaplasma (1). Virtually all patients have changes in their gut similar to those seen in another so-called autoimmune disease called Crohn's disease (2). Other evidence of infection is that sufferers often have high blood levels of IGG and IGA antibodies that the body produces to kill Klebsiella bacteria that normally live in the intestines of healthy people (3,4,5,5A) and that the disease appears to be transmissible (6). The surface structure of Klebsiella contains 2 molecules similar to that of a genetic marker for ankylosing spondylitis called HLA-B27. When the pain is severe, large amounts of Klebsiella are found in stool samples, and those with ankylosing spondylitis often have intestinal ulcers in the end of the small intestine. A low starch diet that reduces the concentration of klebsiella has been reported to alleviate the back pain (7). Another recent study shows that ankylosing spondylitis may be spread from person to person. The next step is to see if long-term treatment with antibiotics, such as doxycycline, azithromycin, metronidazole or a quinolone can be effective in treating ankylosing spondylitis. The disease rarely goes away by itself (12). Please check with your doctor. See report #J103.
By Gabe Mirkin, M.D., for CBS Radio News
1) U Lange, M Berliner, W Weidner, HG Schiefer, KL Schmidt, K Federlin. Ankylosing
spondylitis and infections of the male urogenital tract: Exploration of urinary tract
infection in correlation to rheumatologic parameters. Zeitschrift Fur Rheumatologie 55: 4
(JUL-AUG 1996):249-255. 2) H Mielants, M Devos, C Cuvelier, EM Veys. The role of GUT inflammation in the
pathogenesis of spondyloarthropathies. Acta Clinica Belgica 51: 5 (OCT 1996):340-349. 3) O Makiikola, K Lehtinen, K Granfors. Similarly increased serum IgA1 and IgA2 subclass
antibody levels against Klebsiella pneumoniae bacteria in ankylosing spondylitis patients
with/without extra-articular features. British Journal of Rheumatology 35: 2
(FEB,1996):125-128. 4) O Ardicoglu, MB Atay, H Ataoglu, N Etiz, H Ozenci. Ig A antibodies to Klebsiella in
ankylosing spondylitis. Clinical Rheumatology 15: 6 (NOV1996):573-576. 5) Y Tani, H Tiwana, S Hukuda, J Nishioka, M Fielder, C Wilson, S Bansal, A Ebringer.
Antibodies to Klebsiella, Proteus, and HLA-B27 peptides in Japanese patients with
ankylosing spondylitis and rheumatoid arthritis. Journal of Rheumatology 24: 1 (JAN
1997):109-114. 5A) O Makiikola, R Hallgren, L Kanerud, N Feltelius, L Knutsson, K
Granfors. Enhanced jejunal production of antibodies to Klebsiella and other Enterobacteria
in patients with ankylosing spondylitis and rheumatoid arthritis. Annals of the Rheumatic
Diseases 56: 7 (JUL 1997):421-425. 6) S Weinreich, J Capkova, B Hoebehewryk, C Boog, P Ivanyi. Grouped caging predisposes
male mice to ankylosing enthesopathy. Annals of the Rheumatic Diseases 55: 9 (SEP
1996):645-647. 7) A Ebringer, C Wilson. The use of a low-starch diet in the treatment of patients
suffering from ankylosing spondylitis. Clinical Rheumatology 15: Suppl. 1 (JAN
1996):62-66. 8) SGM Meuwissen, JBA Crusius, AS Pena, AJ Dekkersaeys, BAC Dijkmans.
Spondyloarthropathy and idiopathic inflammatory bowel diseases. Inflammatory Bowel
Diseases 3: 1 (SPR 1997):25-37. 9) K Granfors. Host-microbe interaction in HLA-B27-associated diseases. Annals of
Medicine 29: 2 (APR 1997):153-157. 10) H Tiwana, C Wilson, RS Walmsley, AJ Wakefield, MSN Smith, NL Cox, MJ Hudson, A
Ebringer. Antibody responses to gut bacteria in ankylosing spondylitis, rheumatoid
arthritis, Crohn's disease and ulcerative colitis. Rheumatology International 17: 1 (MAY
1997):11-16. Klebsiella in the pathogenesis of AS and Proteus in RA. The role of
Klebsiella in inflammatory bowel disease requires further study. 11) W Kuon, R Lauster, U Bottcher, A Koroknay, M Ulbrecht, M Hartmann, M Grolms, S
Ugrinovic, J Braun, EH Weiss, J Sieper. Recognition of chlamydial antigen by
HLA-B27-restricted cytotoxic T cells in HLA-B*2705 transgenic CBA (H-2(k)) mice. Arthritis
and Rheumatism 40: 5 (MAY 1997):945-954. 12) Y Tani, H Sato, N Tanaka, S Hukuda. Antibodies against bacterial lipopolysaccharides
in Japanese patients with ankylosing spondylitis. British Journal of Rheumatology 36: 4
(APR 1997):491-493. 13) KC Mounzer, MJ Dinubile. Prophylactic use of antibiotics and vaccines in patients
with rheumatologic disorders. Rheumatic Disease Clinics of North America 23: 2(MAY
1997):259. 14) JT Gran, JF Skomsvoll. The outcome of ankylosing spondylitis: A study of 100
patients. British Journal of Rheumatology 36: 7 (JUL 1997):766-771.
Reported 9/1/97; Checked 9/5/05