Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group HLA B27

and hypothesize we must if we are ever going to figure this out. Keep in mind also, I don't like to say this, but these small tribes are marrying each other cousins. This plays a major role in their genetic makeup and ability to ward off genetic disease. This is why their population has 50% hbla. I have a picture of my tGrandFather taken in 1918 playing in a oompa band from rural Arkansas. The picture also has six of my Uncles. They all married each other sisters. Charles

Edited by oilme on 04/25/02 05:28 AM (server time).

Edited by oilme on 04/25/02 05:35 AM (server time).

Welsh by parentage, but born in England and educated in Scotland!

David

We are coming to a common point here, which is that the Klebsiella-HLAB27 molecular mimicry theory is one of many theories which have been proposed to explain the relationship of HLAB27 with AS, and that the Klebsiella-HLAB27 molecular mimicry theory is CONTROVERSIAL in the medical literature. In medline, there are over 200 citations that come through in a search for "Klebsiella AND ankylosing spondylitis". I will agree that there are reports in the medical literature that support it, just as I can readily find reports in the literature that refute it.

There is nothing at all "glib" about placebo response rates in trials of treatments for AS, which run in the range of 20-40% depending on the report:

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11508441&dopt=Abstract
Anderson JJ, Baron G, van der Heijde D, Felson DT, Dougados M.
Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis.
Arthritis Rheum. 2001 Aug;44(8):1876-86.
PMID: 11508441
‘…Among all 923 patients, improvement rates using this criterion were 49% for NSAID-treated patients and 24% for placebo-treated patients."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7973477&dopt=Abstract
Dougados M, Nguyen M, Caporal R, Legeais J, Bouxin-Sauzet A, Pellegri-Guegnault B, Gomeni C.
Ximoprofen in ankylosing spondylitis. A double blind placebo controlled dose ranging study.
Scand J Rheumatol. 1994;23(5):243-8.
PMID: 7973477
"…percentage of responders… in the placebo group (21%)."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6752873&dopt=Abstract
Jajic I, Nekora A, Chadri HA.
[Pirprofen, indomethacin and placebo in ankylosing spondylitis. Double-blind comparison].
Nouv Presse Med. 1982 Aug 28;11(33):2491-3. French.
PMID: 6752873
"…The overall therapeutic results were judged by the investigator to be satisfactory in…29% in the placebo group."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8961905&dopt=Abstract
Clegg DO, Reda DJ, Weisman MH, Blackburn WD, Cush JJ, Cannon GW, Mahowald ML, Schumacher HR Jr, Taylor T, Budiman-Mak E, Cohen MR, Vasey FB, Luggen ME, Mejias E, Silverman SL, Makkena R, Alepa FP, Buxbaum J, Haakenson CM, Ward RH, Manaster BJ, Anderson RJ, Ward JR, Henderson WG.
Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study.
Arthritis Rheum. 1996 Dec;39(12):2004-12.
PMID: 8961905
"…Response rates were … 36.1% for placebo .."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10555027&dopt=Abstract
Clegg DO, Reda DJ, Abdellatif M.
Comparison of sulfasalazine and placebo for the treatment of axial and
peripheral articular manifestations of the seronegative spondylarthropathies: a
Department of Veterans Affairs cooperative study.
Arthritis Rheum. 1999 Nov;42(11):2325-9.
PMID: 10555027
"…Of the patients with axial disease, 43.3% of the placebo group met the predefined response criteria… Of the peripheral articular group…42.7% of the placebo-treated patients showed a response

Edited by Evelyn on 04/25/02 09:29 AM (server time).

the issue of diet re:spondyloarthropathy rates in the indigenous circumpolar populations came up further down the thread. There have been comparisons made between the Inuit in Alaska and the genetically related indigenous population in northermost Russia. The Alaskan group has "shifted away" from the traditional diet, while their Russian counterparts have retained a more traditional diet, and no difference could be found in their rates of development of spondyloarthropathies:
https://www.kickas.org/cgi-bin/w3t/showthreaded.pl?Cat=&Board=support1&Number=50024&page=0&view=expanded&sb=5&o=365&vc=1#Post50024

I think we had this exchange of views before. The point is, your abstracts give the placebo response in drug trials, where the placebo is chemically neutral. A clinical trial for the diet would compare a low starch diet with a starchy one. There would be no placebo - the patient will know what he is eating! Of course the clinical assessor will not. The only clinical report so far is A Ebringer, C Wilson 'The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis', Clinical rheumatology, 1996, 15, Suppl.1, 61-65. Until this work is done again according to the required protocols I think it unfair and misleading to refer to outcomes from drug trials where the design will be rather different. It just seems like an easy (glib) way of dismissing an argument. And the high response rate from these drug trials doesn't stop docs from prescribing the pills! I sometimes think the reason docs are reluctant to try the dietary route is because it is a damn site easier and quicker to write a prescription and have confidence the patient will take it than to put in the time and effort to try and persuade someone to alter eating habits. It took Ebringer years with me.

Actually, I'm now into year 6 of the placebo effect ... does it last so long with the smarties?

I don't know what the "smarties" thing is all about, nor is the issue of the placebo response rate either "easy" or "glib." In controlled studies it matters equally that the patient group would be "blind" as to whether they are receiving an experimental treatment or a placebo.

There could well be alternate explanations for why a diet might have benefit that do not have anything to do with any proposed theoretical basis relating to the molecular mimicry theory..

Edited by Evelyn on 04/25/02 10:27 AM (server time).

Didn't mean to be cheeky Evelyn, arguing with you is educational and I appreciate the time you take to make your point of view. 'Smarties' is english slang for placebo pills.

In a dietary trial the patient cannot be blind as to what is being eaten, the clinical design will be different. When I took part in such a preliminary trial back in the early 80's they used to measure klebs numbers per gram of stool, serum IgA, ESR as well as other things. And I hated it, couldn't wait to resume a normal diet. Certainly wasn't predisposed to feel good!

Your last point might be true. Whatever the scientific problem that is always true. But you don't just throw the bath water out with the baby. Or do I mean the theory of how you got there is important to if the trial works out.

I'm glad that we can agree to disagree respectfully. Is the baby the diet or the molecular mimicry theory?

Very good Dan, you are so close to a possibility offered by one of the Researchers who studied the Haida.

The following paragraphs were in the conclusion of the summary (by one of the researchers) that I have been reading.



"The interesting results of these studies were to show that about 50 % of the Haida communities were B27 positive. Thus a half of them were susceptible to ankylosing spondylitis and among the men, at least about 10 % of them achieved the disease.

No one knows why the Haida have so much B27. This is the highest frequency so far known in the world. The next highest frequency is in Norwegian Lapps who run about 30 %. Most North American Indians run about 20 %.

There have been myths about the Haidas and where they came from. One rumour had it that they were Polynesian in origin. From HLA studies and other blod grouping studies, it is clear that the Haidas are related to other North American Indians who came across the land bridge from Siberia some 11,000,000 years ago. They are obviously somewhat different. It may have been that the small group of people who started the Haida nation, by accident contained a lot of B27 and therefore this condition persisted in the subsequent communities.

But there is an intriguing possibility beyond this which I (researcher) don't think has ever been explored. In the early 1800's, there were some 8,000 to 10,000 Haidas living on the Queen Charlotte Islands. Through the decimation of smallpox, tuberculosis, venereal disease, etc, brought with the explorers of that time, the population was reduced to some 600 Haidas by the start of the 1920's.

If the B27 antigen conferred some resistance to these diseases, then the B27 positive people would have had a survival advantage and the antigen may also have become concentrated. A speculation, of course but it is an interesting thought."

A comment at the end suggested that they did look at their diet but couldn't find anything that seemed to have any effect.

I have requested a complete copy of the studies from one of the researchers and expect to hear back from him within a few days.

George


Breb Assyl

George it would seem to me there are two diffrent reasons why the American Indians and the People of Haida have higher incidents of HALB 27. First when the sailors form Europe came they brought diease. HALB 27 negitive had some resistive power to small-pox and other dieases form Europe. Because these populations sufferd such devestating losses from these dieases it would seem that the populations would have a higher rate of resistan genetic markers.
People from Nothern Climates would have had a higer intake of meat and fat products. (Less Starch.) Fewer ancestor were eaten by the saber tooth tiger because AS did not show up at an earlier age. Life spans was only about 40 years old so they did not see late onset of AS either, Therefore a greater number of people carring the HLAB 27 neg. Survived in the general population.