Association of macroscopic gut inflammation with disease activity, functional status and quality of life in ankylosing spondylitis

Hascelik, G; Oz, Bengi; Ölmez, Neşe; Memiş, Asuman; Yörük, Gazi; Ünsal, Belkıs; Ekıncı, Neşe

doi:10.1007/s00296-008-0766-6

Cited by 14 publications

(10 citation statements)

References 14 publications

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“…These findings are contrary to those of a previous study that showed serum levels of acute phase reactants to be similar in patients with AS, regardless of gut inflammation. However, in their study, higher bath AS disease activity index scores were found in patients with gut inflammation than in those without gut inflammation [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Ileocolonoscopic findings in patients with ankylosing spondylitis: a single center retrospective study

Ahn

Bae

Lim

et al. 2017

Korean J Intern Med

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Background/AimsIn some Western countries, up to 50% of patients with ankylosing spondylitis (AS) have subclinical gut inflammation. This study was conducted to evaluate the prevalence and severity of gut inflammation and to determine clinical factors associated with colonic inflammation in Korean AS patients who performed ileocolonoscopy without evidence of established inf lammatory bowel diseases before.MethodsOne hundred and eight AS patients who underwent ileocolonoscopy were included in this study. Patients were divided into two groups based on gross ileocolonoscopic findings; patients with inflammatory lesions, and patients without inflammatory lesions.ResultsInf lammatory lesions in ileocolonoscopic findings were found in 40 patients. The Ankylosing Spondylitis Disease Activity Score C-reactive protein was higher in the group with inflammatory lesions and gut lesions were found often in the terminal ileum. The risk of inflammatory lesions was higher for AS patients whose symptoms required ileocolonoscopy than for AS patients who underwent routine ileocolonoscopy screening (odds ratio, 3.96). However, abnormal lesions were detected also in 17.6% of the patients who underwent ileocolonoscopy for routine screening and most of them were erosion and ulcer. Among patients with inflammatory lesions (n = 40), 23 showed subclinical gut inflammation associated with AS and 17 were diagnosed finally as Crohn’s disease (n = 12), intestinal tuberculosis (n = 4), and ulcerative colitis (n = 1).ConclusionsOur findings suggest that ileocolonoscopy might be recommended regularly in AS patients even without gastrointestinal symptoms, especially in the patients with high AS activity.

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Section: Discussionmentioning

confidence: 99%

Ileocolonoscopic findings in patients with ankylosing spondylitis: a single center retrospective study

Ahn

Bae

Lim

et al. 2017

Korean J Intern Med

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“…There are also HLA diVerences: AS is associated with the class I HLA-B27 and RA with the class II HLA-DR4. It is also likely that at least a mild degree of inXammation of the bowel may be evident in those with AS [31], while this is generally considered absent in RA. Additionally, the mechanisms of joint damage also diVer, with the synovium being critical in RA as opposed to bone in AS [32].…”

Section: Inxammatory Arthritis and Disturbed T Cell Functionmentioning

confidence: 93%

T helper cell subsets in arthritis and the benefits of immunomodulation by 1,25(OH)2 vitamin D

et al. 2011

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The prevalence of vitamin D deficiency has been shown to be increased in many of the common arthritides. Importantly, vitamin D has significant immunomodulatory effects in addition to its role in calcium homoeostasis. Both aspects of its function have a major bearing on joint disease whether as part of an inflammatory arthritis or from wear and tear. While the exact mechanisms still require clarification, there is now compelling evidence that the hormonally active 1,25-dihydroxycholecalciferol vitamin D can reduce the activity of the proinflammatory Th1 and Th17 T cell subsets. Additionally, it is stimulatory of enhanced anti-inflammatory Th2 activity at the same time as promoting T regulatory cell activity. These various actions suggest that correcting vitamin D deficiency should be a important part of the management of all patients with joint disease. For the future, vitamin D analogues with enhanced immunomodulatory properties but with reduced ability to increase calcium are being investigated.

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“…It is well documented that there is a strong link between gut inflammation [46] and/or AS [47, 48]. The level of total [49] and secretory IgA immunoglobulins [50] increased in the majority of patients with AS.…”

Section: Evidence Of Subclinical Microbial Infections In As and CDmentioning

confidence: 99%

The Link between Ankylosing Spondylitis, Crohn’s Disease,Klebsiella, and Starch Consumption

Rashid

Wilson

Ebringer

2013

Clinical and Developmental Immunology

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Both ankylosing spondylitis (AS) and Crohn's disease (CD) are chronic and potentially disabling interrelated conditions, which have been included under the group of spondyloarthropathies. The results of a large number of studies support the idea that an enteropathic pathogen, Klebsiella pneumoniae, is the most likely triggering factor involved in the initiation and development of these diseases. Increased starch consumptions by genetically susceptible individuals such as those possessing HLA-B27 allelotypes could trigger the disease in both AS and CD by enhancing the growth and perpetuation of the Klebsiella microbes in the bowel. Exposure to increased levels of these microbes will lead to the production of elevated levels of anti-Klebsiella antibodies as well as autoantibodies against cross-reactive self-antigens with resultant pathological lesions in the bowel and joints. Hence, a decrease of starch-containing products in the daily dietary intake could have a beneficial therapeutic effect on the disease especially when used in conjunction with the currently available medical therapies in the treatment of patients with AS and CD.

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Association of macroscopic gut inflammation with disease activity, functional status and quality of life in ankylosing spondylitis

Cited by 14 publications

References 14 publications

Ileocolonoscopic findings in patients with ankylosing spondylitis: a single center retrospective study

Ileocolonoscopic findings in patients with ankylosing spondylitis: a single center retrospective study

T helper cell subsets in arthritis and the benefits of immunomodulation by 1,25(OH)2 vitamin D

The Link between Ankylosing Spondylitis, Crohn’s Disease,Klebsiella, and Starch Consumption

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