Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Evidence or Info that ReA turns into AS??

Hi All,
I know it has mentioned in posts that usually after two years of having ReA that it turns into AS. Does anyone know of any research or links to confirm this (John??). I mentioned this to my rheumy and was told there is absolutely no truth to that pressuposition and no evidence to ever suggest that Reactive Arthritis/Reiter's Syndrome ever turns into AS. If I attempt to bring it up again I am going to need some evidence. I have done some searching myself and haven't seen anything on this topic.
Anyone?

Rene a.k.a Julie

Hey Rene,

Here is a bit of info I will send you some more later. You might want to let your doctor also know Julius Reiter's name was stripped from this disease and it is now called Reactive Arthritis. see link http://www.drmirkin.com/morehealth/8735.html

Brent

http://www.nass.co.uk/questions.htm

What causes AS?

We're not entirely sure. So far medical research has shown that 96% of people with AS in Britain all share the same genetic cell marker - Human Leucocyte Antigen B27 (HLA-B27). It is possible that some normally harmless micro-organism, which on this occasion the immune system cannot fight, comes into contact with HLA-B27 and sets up an adverse reaction. Sometimes bowel infections appear to spark off AS. Symptoms may also become apparent after a period of enforced bed rest, for example following a car accident, accelerating a previously existing mild condition. A group of symptoms known as Reiter's Syndrome may also lead to AS. These include iritis (or uveitis) which is inflammation of part of the iris; and conjunctivitis which causes red, gritty and painful eyes. People with Reiter's Syndrome also suffer from urethritis. This is inflammation of the urethra, the tube that conveys urine from the bladder out of the body. This results in pain on passing urine, discharge on the end of the penis (especially on waking up in the morning) and an increased frequency of passing urine. Women may get the pain but won't notice a discharge from the urethra. Reiter's Syndrome also results in arthritis, affecting the large joints, especially in the legs, together with pain in the joints of the lower back particularly at night or on waking.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15016341
Sieper J.
Disease mechanisms in reactive arthritis.
Curr Rheumatol Rep. 2004 Apr;6(2):110-6. Review.
PMID: 15016341
"Reactive arthritis (ReA) occurs after a preceding bacterial infection of the urogenital or gastroenteral tract. The bacteria triggering ReA persist in vivo and seem to be responsible for triggering an immune response. A cytokine imbalance with a relative lack of T-helper 1 cytokines may play an important role allowing these bacteria to survive. This seems to be relevant for manifestation and chronicity of the arthritis. For the chronic cases and cases evolving into ankylosing spondylitis, the interaction between bacteria and human leukocyte antigen B27 plays an additional crucial role. Among others, the arthritogenic peptide hypothesis is one way to explain this association. Human leukocyte antigen B27-restricted peptides from Yersinia and Chlamydia, which are stimulatory for CD8+ T cells derived from patients with ReA, have been identified. The exact role of such peptides for the pathogenesis of ReA and other spondyloarthritides still has to be defined. "


http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9891708&dopt=Abstract
Leirisalo-Repo M.
Prognosis, course of disease, and treatment of the spondyloarthropathies.
Rheum Dis Clin North Am. 1998 Nov;24(4):737-51, viii. Review.
PMID: 9891708; UI: 99108857
"…In about 15% to 30% of such patients [patients with reactive arthrits], the disease progresses, and spondyloarthropathy and even ankylosing spondylitis develop in the following 10 to 20 years."

from text:
"…During the few years after an acute episode, mild joint pain or enthesopathy is common in patients with previous reactive arthritis. Also, one third has occasional attacks of low back pain. [20] [23] [47] In 14% of patients with previous postenteric reactive arthritis, signs and symptoms of chronic spondyloarthropathy have been described to occur. [40] During the next 10 to 20 years, recurrent attacks of acute reactive arthritis seldom occur in patients with previous Yersinia arthritis but are more frequent in patients with previous Salmonella or Shigella arthritis (Table 1) . Depending on the triggering infection and on the follow-up time, chronic arthritis is observed in 2% to 18%, sacroiliitis in 14% to 49%, [45] and ankylosing spondylitis in 12% to 26% [44] [68] (Table 1)… ."

WOW THANKS EVELYN and BRENT

I had no idea..... So it sounds like a certain percentage may go onto develop AS. Hmmmm. I will definately click on the links you provided, read more and present to my physician. So great that there is actually articles on this topic!
Thanks again



Rene a.k.a Julie

Evelyn,

you do us proud!

Thanks for the links!!!!!! A life saver if ever I virtually met someone.....

David

IBD=It's Been Dreadful

Hi DAVID!!

I'll say, that was great. It's like she pulled it out of a hat!!

Hope you are ok DAvid-How's summer? Is it summer there?


Rene a.k.a Julie

Renee,

yes and no.......it's here sometimes but it's still spring and we need the rain the dams are @ 30%.

From
Therapy of spondylarthropathy in inflammatory bowel disease
S. Generini, G. Fiori, M. Matucci Cerinic

Clin Exp Rheumatol 2002; 20 (Suppl. 28):
S88-S94.


PM me I'll email these to you as I acquired them!!!!!

In reply to:

---

Two primary patterns of arthritis have
been described in IBD: 1) peripheral,
often asymmetric, arthritis, and 2) an
SpA resembling idiopathic ankylosing
s p o n dylitis (AS) in 10% of pat i e n t s
with ulcerat ive colitis and less commonly
in patients with CD (4). This
p e ri p h e ral art h ritis re c e n t ly has been
subdivided into three types: type I, peripheral
pauciarticular arthritis with < 5
joints involved; type II, peripheral nonsymmetric
polyarthritis with ³5 joints
involved; and type III, an SpA, sometimes
with peripheral

---

I n fluence of the gut and cytokine pat t e rns in spondy l o a rt h ro p at hy
D. Baeten, F. De Keyser, N. Van Damme, E.M. Veys, H. Mielants

Next From:

Clin Exp Rheumatol 2002; 20 (Suppl. 28):
S38-S42.

In reply to:

---

Introduction
Spondyloarthropathy (SpA) is a group
of autoimmune disorders of the joint
which includes ankylosing spondylitis
(AS), reactive arthritis (ReA), psoriatic
arthritis (PsA), arthritis associated with
i n fl a m m at o ry bowel disease (IBD),
and undifferentiated SpA. The different
types of SpA share a number of
common cl i n i c a l , ra d i o l ogi c a l , a n d
genetic features that are clearly distinct
from RA. Clinically, SpA is characterized
by both axial and peripheral joint
involvement. The involvement of the
axial skeleton with sacroiliitis and/or
spondylitis is probably the most important
hallmark. Peripheral joint involvement
is mostly mono- or pauciarticular
and asymmetri c. It affects pre d o m inantly
the lower limbs (knees and ankles)
and is frequently associated with
enthesitis (Achilles tendon, fa s c i a
p l a n t a ris). Radiologi c a l ly, the evo l ution
of both axial and peripheral joint
disease is characterized rather by bone
formation than bone erosions, leading
eventually to ankylosis.

---

Tell your Dr to start reading!!!

David

IBD=It's Been Dreadful

Renee,

had the same battle with my GP/PCP on all these matters B27 -ve do n't get SpA, B27-ve's do not fuse, SpA can't change into ankylosing.

Pain, AS/SpA is not painful.

That arms and legs get problems as well as axial joints

That there can be nerve involvement, that discs get munched etc.......

They can diagnose eye problems with a quick look

It;'s your shoes causing plantar fanscitis......

Your pain in the joints and muscles are linked to IBD symptons,

That nsaids can't make you worse.......

It's not us, it's the Dr.s who are the problem!!!! They are not current and they think they are infallible..........

Sorry on my Soap Box today, must be feeling better!

David

IBD=It's Been Dreadful

Evelyn,
Thanks for sending the links about reactive arthritis.
I was diagnosed with reactive arthritis two years ago.
I will check out this information.
Thanks again
Kevin

Well, this is not going to be particularly helpful, since I don't have a specific cite or link, but I'm sure I've read at least one paper putting forth the idea that ALL the spondyloarthropathy's are a kind of reactive arthritis...that Reiter's is a simply AS with a subset of symptoms and not really an entity unto itself, or rather, AS is just a form of Reiter's.

The overlap to me has always seemed to point out the limitation of the clinical distinctions made among the SpAs, except in making guesses at how the disease will progress, which might apply to groups, though not a specific patient.