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Ankylosing Spondylitis Research

This site summarizes the latest research in AS
This site is
sponsored by :

NASS
(National Ankylosing
Spondylitis Society)
 
 
 
 

What is inflammatory bowel disease

There are 2 types:

1. Crohn's disease has abdominal pain, weight loss and diarrhea. Low fever is common. At later stages abscesses appear in the gut. These areas of inflammation can affect the entire length of the gut. There are areas of normal gut next to areas of inflamed gut, therefore patches of inflammation.

2. Ulcerative colitis has diarrhea and blood loss. Weight loss is less common. The ulcers and areas of inflammation are mainly in the lower gut (the colon) and all of the area will be involved, there will be no patches of normal gut wall (as is seen in crohn's disease).

About 10-25% of people with inflammatory bowel disease develop a form of arthritis (8% of people with ankylosing spondylitis have inflammatory bowel disease).

People with severe bowel disease (ie extensive and not limited to a small area of the gut) are more likely to develop the arthritis symptoms.

Why is it associated with spondylarthritis

Gut inflammation and spondylarthritis are very closely linked. It is thought that the trigger for ankylosing spondylitis is a gut infection. For example, Salmonella, Klebsiella, Campylobacter, Shigella, Yersinia infections (and Chlamydia a urinary infection) are associated with the development of arthritis. 
 


In people with AS who do not have any bowel symptoms, half (50%) will have evidence of gut inflammation. This means that people can have inflammation and infection in their gut without knowing it. The bacteria may get in though the inflamed gut to 'trigger' AS and may or may not develop into diagnosable inflammatory bowel disease in the future.

This means that people with the genes to develop spondyloarthropathy will not develop the disease if they are not exposed to the gut infection. However, only people with specific genes will react to the gut bacteria by developing arthritis. Therefore, the link with bowel disease and arthritis is both due to shared genetics and environmental (i.e. getting a gut infection) reasons.

People with AS are more likely to have a relative with bowel disease (and not arthritis) and people with bowel disease are more likely to have a relative with spondyloarthropathy. This means there are genes in common for both these inflammatory diseases. The genes that cause one disease may also be involved in causing the other disease.

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How is it treated

Sulphasalazine is used to treat inflammatory bowel disease. This is very good for ulcerative colitis but there is less evidence that it works well in crohns disease. It is also good at treating the arthritis associated with bowel disease. It works best in people with early disease and people with arthritis outside the spine i.e. hands, feet, shoulders etc. 

Corticosteriods are used for controlling the inflammation of the bowel disease and arthritis. However, steroids do have serious side effects if taken for a long period of time (i.e. osteoporosis, moon face, thinning skin, diabetes).

Methotrexate helps arthritis in joints outside the spine i.e. hands, feet, shoulders and is effective for crohns disease. 

Cyclosporine is successful in treating psoriasis and high doses can help reduce inflammatory bowel disease which is not responding to steroids. 

Anti-TNF (i.e. infliximab) works in crohns disease but not for ulcerative colitis. It brings about rapid and substantial improvement and remission of the intestinal inflammation. 

References :

Generini S, Forri G, Matucci Cerinic M. Therapy of spondylartropathy in inflammatory bowel disease. Clin Exp Rheumatol 2002; 20 (Suppl. 28): S88-S94.

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