Talk:Ankylosing spondylitis

This is just WRONG. It doesn't start at age 10

 "AS typically begins in the second or third decade of the person's life and occurs more often in males."

You start your SECOND decade at age 10, and your THIRD decade at age 20. You probably meant to say "AS typically begins in your 20s or 30s"

Add my pic if you want

There's a part in this page where Arx Fortis has suggested getting a better picture, and a comment by Sensei on getting a picture showing the process of ankylosing. Most of the X-Ray or MRI pics don't make much sense to the ordinary person, except for one in the Diagnosis section which shows a bamboo spine. You can use my pics if you want; there are two pics, and the first one shows that the lower spine is fused but the upper vertebras are still free:

http://postimage.org/image/d87a9ocdp/

http://postimage.org/image/jboutl2nh/

I'm male, 30 years old. I had a disc injury L4-5 in 1999. Took bed rest for a month; the back pain and sciatica continued for at least two years, and even after that I had pain in the entire back, though it was much less. Fortunately I didn't need any injections or surgery. All these years, my back has been paining off and on, and if I sit for more than fifteen minutes, it gets stiff. The pain however is very less, I can easily ignore it. I think I had AS for quite some time but I kept attributing the pain to the disc injury. I don't remember much about how severe the pain was in all these years. This year I visited my doc again, and first he called it AS, but then changed it to Spondyloarthropathy after the HLA B-27 test came out negative. I've started Sulfasalazine once a day now, along with Naproxen twice. J.Bhargav (talk) 03:58, 5 March 2012 (UTC)

All pictures used in Wikipedia must come from (be legally released to) Wikimedia commons. We can't use "outside" and possibly copyright-implied photos. It is possible that these x-rays might be "owned" or partially so, by the technician/firm that took them.

Having said that, a sufferer myself, I find x-rays hard to understand. A drawing omitting "unnecessary" details (and released to Wikimedia! :) might be better. Thanks. Student7 (talk) 15:42, 9 March 2012 (UTC)

I know that this pic is mine; I've the hard copy as well. I'm not sure if the clinic where I got these pics taken have any rights over them. I doubt they even keep a copy of them. As for the X-Ray itself, I generally don't understand X-Rays myself, but I think mine is pretty clear: you can see the fusion on the lower vertebras, along with the formation of what they call Snydesmophytes. I'll edit out the unnecessary parts once I'm told I can upload the pic to Wikicommons. But this is if you people actually want to put it up on the main page. J.Bhargav (talk) 07:39, 11 March 2012 (UTC)

The other problem with Wikicommons is that we can't, in this day of photoshopping, "adjust" pictures. Credibility. My understanding is that the image must be untouched. Another reason for a good drawing, if one can be found. Hard to include "just" the ankylosing on an x-ray. Student7 (talk) 14:04, 12 March 2012 (UTC)

I'll leave the X-Ray image as it is then. There's not much point showing just the ankylosing without showing the non-ankylosed parts as well. And I'm not a doctor, so I don't understand the X-Ray fully myself, which is why I'd rather have a person with medical knowledge edit the page. But I need someone, an admin, to tell me whether or not they'll put this image on the page. Unless I receive confirmation, I won't upload the image to Wikicommons. J.Bhargav (talk) 02:27, 13 March 2012 (UTC)

Is Ankylosing spondylitis is still un-curable?

Is there any new finding in research? — Preceding unsigned comment added by 117.213.245.51 (talk) 18:20, 16 April 2012 (UTC)

Not a cure as such but there are two main alternative treatments that I know of which people are using. There really ought to be a section on alternative treatments, such as:

a) No starch diet (NSD) / Low starch diet - works well for some people. London Diet is another name for this diet. See: http://www.kickas.org/londondiet.shtml some info on the theory behind this is here: http://www.kickas.org/molecular_mimicry.shtml

b) Antibiotic protocols - such as the Marshall Protocol. See: http://marshallprotocol.com/ and http://mpkb.org/ and http://www.roadback.org/

There are some other more colourful ones.. such as in Russia I have heard of people sitting in a pool around a radioactive rock. Supposedly the radiation kills off the excess of white blood cells.

Besides these alternative therapies there are also Biologics which definitely need a mention on this page. These were initially quite dangerous (e.g.: side effects such as death and chronic infection) however they seem to be moving along quite well in improving the safety of these drugs. 129.78.233.211 (talk) 00:10, 26 April 2013 (UTC)

I would imagine antibiotics can kill the Klebsiella, and hence reduce the immune response. All the best: Rich Farmbrough, 19:45, 25 September 2014 (UTC).

Epidemiology needs rewrite

An editor tried to rewrite the section from Braun,Spieper. Ankylosing Spondylitis.Lancet 2007; 369: 1379–90 (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2960635-7/fulltext) by just copying the text. I agree that a rewrite is needed, and that this source would be an improvement, but it needs to be done without such copyright problems. --Ronz (talk) 16:12, 10 October 2012 (UTC)

Here's the book by the same authors: http://www.scribd.com/doc/50854946/5/Epidemiology-of-ankylosing-spondylitis --Ronz (talk) 16:18, 10 October 2012 (UTC)

Ankylosing spondylitis prevalence is between 0.1 and 0.2% of the general population.

But above we see 1.8...

Jidanni (talk) 22:58, 24 October 2017 (UTC)

Different sources say different things.[1] Doc James (talk · contribs · email) 02:03, 25 October 2017 (UTC)

Bechterew

The name of the disease shows divided usage but is commonly known as Bechterew's [[2]] after one of its discovers. While the rendition of his name may changed recently to a romanized form in some places, the widely used German form of the name of the disease has not, so this should be included. See for example the German Wikipedia[[3]]. I use a fixed ip. — Preceding unsigned comment added by 62.3.255.103 (talk) 21:47, 23 February 2013 (UTC)

Management

The article is very good- apart from one inaccuracy. The article states that opiate pain medication is addictive and rarely prescribed. It is commonly prescribed, even long term. If you wish to keep this information please cite it- as an AS sufferer, and one who knows of thousands of people with AS who ARE on narcotic pain meds, long term, this bit of the article is not accurate. 68.12.209.49 (talk) 16:49, 22 August 2013 (UTC)

DMARDs

This article says that DMARDs are used. The Lancet says that they're not effective for the axial symptoms. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961134-4/abstract Anti-interleukin-17A monoclonal antibody secukinumab in treatment of ankylosing spondylitis: a randomised, double-blind, placebo-controlled trial Lancet, online first, September 13, 2013

Which is it? Does anybody have a good, recent source?

The Lancet also had some promising results with secukinumab, although it was only 30 patients. --Nbauman (talk) 00:26, 16 September 2013 (UTC)

Low starch

(See also a few sections up.) http://www.ncbi.nlm.nih.gov/pubmed/8835506 refers. Is there no further work on this? All the best: Rich Farmbrough, 19:46, 25 September 2014 (UTC).

I was diagnosed with AS in 2013, and have followed the London AS Diet (mentioned in the article, and proposed by Prof A. Ebringer) with great results; so little in the way of symptoms that it could almost be considered a cure (as long as you continue with the diet). I would like to have this more directly included in the "Treatment" section of the article, with appropriate caveats that this approach is based on a hypothesis that has not been proven (although there's plenty in the way of citations!) - however, as someone who actually HAS the disease, this could arguably be considered a conflict of interest and possibly not WIKIPEDAI:NPOV. Can I ask the thoughts of other editors on this page? if nobody feels desperately strongly, I'll have a go at creating some suitable language.FDCWint (talk) 17:09, 3 January 2015 (UTC)

Ankylos

Does it mean crooked? On the ankylosaur page it suggests fused. — Preceding unsigned comment added by 194.176.105.153 (talk) 09:01, 10 April 2015 (UTC)

Contradicted by literature review

I have moved this paragraph here for discussion:

The London AS Diet was developed by Professor Alan Ebringer at the Ankylosing Spondylitis Research Clinic, Kings College, London. It is a low starch diet.

Professor Ebringers' team found that Klebsiella bacteria in the colon to be a trigger in AS. The bacteria feed directly on starch, by reducing starch in diet Klebsiella are starved and numbers reduce. This is benificial to patents as this decreases inflammation and therefore symptoms.

The source is a primary source. WP:MEDRS requires secondary sources. Also, this 2006 literature review found "There is little available evidence to support lifestyle modification in AS." Sławomir
Biały 18:54, 16 January 2016 (UTC)

There are two paragraphs removed. Will the paragraph not referred to be reinstated? — Preceding unsigned comment added by 195.55.142.58 (talk) 08:57, 18 January 2016 (UTC)

I only removed the passage quoted above. Sławomir
Biały 12:20, 18 January 2016 (UTC)

The literatre review stated does not state "There is little available evidence to support lifestyle modification in AS." — Preceding unsigned comment added by 195.55.142.58 (talk) 09:06, 18 January 2016 (UTC)

Yes, it does. In the section "Lifestyle modification", p. 426. Sławomir
Biały 12:20, 18 January 2016 (UTC)

Lifestyle modification is an important part of AS management. For example, physiotherapy is considered an important part of the overall management of AS. — Preceding unsigned comment added by [[User:{{{1}}}|{{{1}}}]] ([[User talk:{{{1}}}|talk]] • [[Special:Contributions/{{{1}}}|contribs]])

Furthermore, the above-referenced literature review cited another study finding that diet did not help pain management. Diet studies are notoriously problematic. Sławomir
Biały 20:21, 18 January 2016 (UTC)

Please specify why the paragraph 'The London AS Diet was developed by Professor Alan Ebringer at the Ankylosing Spondylitis Research Clinic, Kings College, London. It is a low starch diet.' has been removed. — Preceding unsigned comment added by 195.55.142.58 (talk) 09:07, 21 January 2016 (UTC)

It was completely unsourced. Sławomir
Biały 12:09, 21 January 2016 (UTC)

HLA B27 test

No diagnosis for AS - not entirely correct. You can test for the protein created by the HLA B27 gene - this is how, after several years of misdiagnosis and ineffective treatment, my wife and I finally found the reason behind her back pain issues. Her levels came back seven times higher than normal when tested.

Ref

Which part supports "It is thought that in some cases a diet low in starches found in flour products and potatoes, and high in proteins and vegetables is of benefit for AS patients."? Doc James (talk · contribs · email) 21:57, 20 October 2016 (UTC)

References

Life expectancy?

User:Doc James changed my edit. As I read the review article, the evidence mostly points towards no difference in life expectancy. This is odd but consistent given the increased specific mortality data cited in the article. It's possible that the condition increases specific mortality from some causes, but also decreases others, so that there is no net decline in life expectancy.

Could James explain why his formulation is superior to mine? "About 30% of those affected have a reduced life expectancy." sounds like it's making the claim that patients come in two identifiable categories, and one of them does not experience any decline in life expectancy. I don't think there is any support for this two category claim. --Deleet (talk) 16:26, 1 November 2016 (UTC)

The categories don't necessarily need to be identifiable apart from one of them having reduced life expectancy. However it may be down to any number of factors, such as the speed at which the disease progresses or how well the patient adheres to treatment. What does the paper you use say? The one I see cited comes to an entirely different conclusion… Carl Fredrik 💌 📧 16:43, 1 November 2016 (UTC)

Ref says "It can be concluded that at least a third of the patients with ankylosing spondylitis have a severe course of disease and a reduced life expectancy."[4]

Unable to find the wording in the ref that supported the version you added. Doc James (talk · contribs · email) 01:29, 2 November 2016 (UTC)

On second reading, I can't find it either. Odd. Let's keep yours. --Deleet (talk) 01:25, 4 November 2016 (UTC)

K sounds good. Doc James (talk · contribs · email) 10:37, 4 November 2016 (UTC)

Relatively newly created umbrella term

IMO this belongs in the body of the article not as its own paragraph in the lead.

"Since 2009, Ankylosing spondylitis is a member of the more broadly defined disease axial spondyloarthritis, which is an the umbrella term created to better diagnose, treat and study less severe forms and early stages of ankylosing spondylitis. "

Others thoughts? Doc James (talk · contribs · email) 14:58, 2 March 2017 (UTC)

Opinion of User on rcde2 on the new umbrella term axial spondyloarthritis

I am currently working for the ankylosing spondylitis patient organization in Switzerland, where I am conducting literature research on current research topics and am in contact with Swiss rheumatologists. During my time here I have gotten the impression that axial spondyloarthritis already is a very important term for the following reasons:

1. High impact reviews on ankylosing spondylitis as well as management recommendations for the disease use the term axial spondyloarthritis instead of ankylosing spondylitis. The rationale behind it is to also include less severe and early forms of ankylosing spondylitis. Literature examples include:

2. Early stage patients so far have been in the disadvantage of not having a specific diagnosis and therefore often lacked the access to appropriate therapy. Due to the new term "axial spondyloarthritis" these patients can be diagnosed at a much earlier point and can therefore profit from better treatment options (see ASAS-EULAR management recommentadions for Europe ) . Since an early treatment has been indicative for a good response to TNF-a inhibitors and hence a slower radiographic disease progression, an early diagnosis is of great importance.

3. Even thought the FDA does not approve TNF-inhibitors for non-radiographic axial spondyloarthris (yet), they have agreed that axial spondyloarthris is an official disease term that includes ankylosing spondylitis.

Okay added a shorter summary to the lead based on that last source "It is also within the broader category known as axial spondyloarthritis." Doc James (talk · contribs · email) 02:43, 3 March 2017 (UTC)

Lancet

doi:10.1016/S0140-6736(16)31591-4 JFW | T@lk 09:53, 7 July 2017 (UTC)