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  • Q&A with Australian Health Practitioners

    What is ankylosing spondylitis?

    Related Topics
    Ankylosing Spondylitis Rheumatology
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  • 7

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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Most commonly, this chronic, progressive form of arthritis especially effects the sacro-iliac, vertebral and costovertebral joints. It is the most common cause for bilateraly, symmetrical sacro-iliitis. 

    It is not well understood, however as Dr Stewart points out, almost all patients are positive for the HLA-B27 antigen. The earlier the onset of AS, the wose the prognosis, with progressive spinal ankylosis within 10 years. 

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    Dr Irwin Lim

    Rheumatologist

    Irwin has been a rheumatologist in Sydney since 2003. He is a co-founder and medical director of BJC Health, which consists of a team of … View Profile

    HLA B27 is an important genetic marker.

    But how useful this marker is, depends on the background population level of HLA B27 positivity.

    In Scandinavian countries, where the population is quite homogenous and the frequency of HLA B27 is higher, the statement that almost all patients are positive for HLA B27 is more true (around 90-95%).

    In Asia, and in Australia given our cultural mix, this is much less the case.

    HLA B27 if positive, in a patient with suspicious symptoms, is useful.

    HLA B27 if negative, in a patient with suspicious symptoms, does not exclude the diagnosis of spondyloarthritis/ Ankylosing Spondylitis.


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    Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed … View Profile

    Hi
    the prognosis of Ankylosing Spondylitis (how the disease will affect you) has improved dramatically over the last few years. While regular moderate exercise and improving fitness are still the mainstay of rehabilitation new medications can reduce the progress of inflammatory and ankylosis dramatically. With less pain, you will be able to keep up your participation in work and leisure activities.

    The Arthritis and Diabetes foundation has information, support group and exercise/education classes weekly in Perth if you have the diagnosis of AS.

    Early accurate diagnois by a rheumatologist will provide you with the best outcomes.

    Helen Potter Specialist Musculoskeletal Physiotherapist,
    In Touch Physiotherapy, Subiaco WA



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    Dr Irwin Lim

    Rheumatologist

    Irwin has been a rheumatologist in Sydney since 2003. He is a co-founder and medical director of BJC Health, which consists of a team of … View Profile

    Hi Helen,

    I'm glad you mentioned new medications.

    The last decade has seen a revolution in the management of Ankylosing Spondylitis (AS).

    For those who do not respond to anti-inflammatory medications (NSAIDs/Cox2 inhibitors) with concomitant exercise, there are now much more effective medications.

    A whole class of medication known as TNF-inhibitors or TNF-blockers.

    TNF has been shown to be a key cytokine/chemical involved in the inflammation of AS (and other spondyloarthritis/spondyloarthropathies such as Psoriatic Arthritis). Medications to block TNF can often lead to dramatic, life-changing improvements.

    This success and excitement has generated a lot more research into the field, so expect to see lots of advances in genetic understanding, pathophysiology, imaging techniques, treatment strategy and actual new therapeutics in the coming years.

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    Dr Aaron Albrecht

    Chiropractor

    Dr. Aaron Albrecht works at Body Wise Chiropractic in Bibra Lake, Western Australia. The clinic is located within a gym, and Dr. Albrecht is the … View Profile

    As the previous panellists have stated, AS tends to affect the spinal and paraspinal (around the spine) joints. It is chronic and progressive, but certain medications and an exercise program including deep breathing to keep the costotransverse joints (the joints between the ribs and the spine) mobile.

    On top of this it should be noted that in some cases there are symptoms which do not involve the skeleton or joints, these systemic complications are fairly rare and only generally occur in advanced stages of disease; they can include changes in the cardiovascular system and renal (kidney) changes.

    - Dr. A

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  • tofep

    HealthShare Member

    Can AS be lot worse in some people than others because i got problems with voiding and i have been told that TNF Alpha inhibitors are not possible for me to take because of the associated ramifications of the drug group. I have also been told by my gastroentorologist that i am unable to take NSAIDs because of persistant reflux and ulcerations in the stomach and throut. Are there other paths that can be taken to lessen the impact of AS for the long term or there is not much hope at this time for me?

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    tofep

    HealthShare Member

    throat*

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Adding a bit to what the clinical health professionals have written:

    A number of inhibitors of TNF-alpha have been approved by the PBS for treatment of ankylosing spondylitis - see http://www.medicareaustralia.gov.au/provider/pbs/drugs1/ankylosing.jsp for more on this.

    They are all genetically engineered monoclonal antibodies which block the action of TNF.

    This is an option which people who live with ankylosing spondylitis could usefully discuss with their clinical health professional care team.

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    Anonymous

    I have read promising accounts of Low Dose Naltrexone being used to treat Ankylosing Spondylitis and other auto immune diseases, with fewer side effects than Biologics, resulting in life changing results/remission.  What are your thoughts on this?  Are you aware of any imminent studies to test LDN on auto immune diseases?  Is this a possible line of treatment in Australia?

    Thanks

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    You might find this free-access review helpful: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/ 

    It summarises the evidence that LDN may be of benefit in inflammatory conditions like Crohn's Disease and multiple sclerosis.

    I don't know of any studies related to LDN and auto-immune diseases (a PubMed search; "naltrexone" AND "autoimmune" did not show anything).

    In Australia naltrexone is on the Pharmaceutical Benefits Scheme list for management of opiate and alcohol addiction but nothing else..

    What that means is that while a doctor could prescribe it for ankylosing spondylitis it would be "off-label" - probably that means that it would be expensive because it would not be eligible for a PBS subsidy.

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