Hi, Evelyn:

There is a rather large section of the AS population that has gone missing!

Quote:

...only 1-2% of HLA-B27 positive people develop AS.



Ok, if this were true there would be MANY fewer people with AS: 2% of 8% is 1.6 per 1000, and the clinically observed incidence of AS is almost certainly close to 4 in 1000; you have reduced the actual number of persons with AS in the United States by more than 1 million (I wish it were that easy--Cured by FIAT!).

I know that there is some older literature in support of your numbers, but most of the researchers have updated their observations and now recognize AS as an emerging disease; the rates are increasing due in part to improved diagnostic tools, but also (I believe) due to lifestyle and drug choices.

FROM Maxime Dougados, et al
Quote:

In continental Europe, prevalence ranges from .2 to 1% of the whole population suggesting that this disease is far from being rare.



FROM Prof. Ebringer's San Antonio lecture
Quote:


(3) HLA-B27: The size of the problem.

It is known that 8% of the US/U.K. populations are HLA-B27 POSITIVE.

Since the population of the U.S is 275 million, there are 22 million people in the U.S. who are HLA-B27 POSITIVE and in the U.K. there are 5 million who are also HLA-B27 POSITIVE.

It is agreed by many workers, that 20% of HLA-B27 POSITIVES have some symptopms of AS.

THUS: THERE ARE 5 MILLION AMERICANS with some symptoms of AS.





About NSAIDs: I'm sure the FDA has done their best to protect us from unintended consequences, and reviewed all the (pharmaceutical company-sponsored) studies. Of course we, as patients, have been given ALL the relevant data! There is no problem with drugs like Vioxx. Bone mineral density may not be the only issue with NSAIDs.

FROM AAOS Buletin
Quote:

In the absence of strong clinical evidence supporting or refuting an inhibitory effect of NSAIDs or COX-2 inhibitors on fracture healing, we can only rely on data from animal studies. A careful analysis of those data show that high doses of drugs that inhibit cyclooxygenase-2 impair bone healing during the time those drugs are administered. Once the drugs are discontinued, animals quickly recover their prostaglandin production and rescue the inhibitory effects. To extrapolate this scenario to a clinical setting, one might imagine that a patient who sustains a fracture or undergoes an operation requiring bone healing might safely be able to take an NSAID or COX-2 inhibitor for one to two weeks and then discontinue the drug. In this case, normal, timely healing might be expected to occur. However, there may be a concern that these drugs would interfere with bone healing when comorbid conditions create settings that are not optimal. For example, are they safe for use in patients who smoke or take glucocorticoids, who have diabetes, or in whom fracture stability or operative fixation is not ideal?



Maybe the missing AS group have just expired:

FROM Reconsider Organization
Quote:

7. "Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
accounts for an estimated 7,600 deaths and 76,000 hospitalizations in
the United States." (NSAIDs include aspirin, ibuprofen, naproxen,
diclofenac, ketoprofen, and tiaprofenic acid.)
Source: Robyn Tamblyn, PhD; Laeora Berkson, MD, MHPE, FRCPC; W. Dale
Dauphinee, MD, FRCPC; David Gayton, MD, PhD, FRCPC; Roland Grad, MD,
MSc; Allen Huang, MD, FRCPC; Lisa Isaac, PhD; Peter McLeod, MD, FRCPC;
and Linda Snell, MD, MHPE, FRCPC, "Unnecessary Prescribing of NSAIDs and
the Management of NSAID-Related Gastropathy in Medical Practice," Annals
of Internal Medicine (Washington, DC: American College of Physicians,
1997), September 15, 1997, 127:429-438, from the web at
http://www.acponline.org/journals/annals/15sep97/nsaid.htm , last
accessed Feb. 14, 2001, citing Fries, JF, "Assessing and understanding
patient risk," Scandinavian Journal of Rheumatology Supplement,
1992;92:21-4.



Regards,
John

Important AS Resources

Professor Ebringer: On Diet and AS;


RED ARROW --> Philippines