Infection and work stress are potential triggers of ankylosing spondylitis.

The objective of the study was to investigate potential triggering events for the onset of ankylosing spondylitis (AS). A large retrospective population survey of 1,080 AS patients was carried out by multi-faceted questionnaire. A nested case-control study compared the cohort to 102 patients with lumbar disc prolapse. Participants with AS had a mean age of 49.8 years, mean age of disease onset was 25.2 years and 63% of the cohort were male. Seventy-nine per cent knew they were human leucocyte antigen (HLA)-B27-positive, and a further 12.5% were unaware of their HLA-B27 status. Infections were relatively common in the 3 months leading to the first symptoms, 4.6% reporting gastrointestinal infection, 2.5% reporting urinary tract infection and 2.6% respiratory infection. Five per cent reported heavy physical activity in the 3 months prior to the onset of symptoms, 4.2% emotional stressors and 3.1% work stressors. Injury and surgery were less commonly reported (1.7 and 0.7%, respectively). Pregnancy was reported by 7.4% of the female participants. When the 12 months leading up to the first symptoms was compared to the 12 months previous to that, work stressors (OR 1.5), and pregnancy (OR 2.5) infection (OR 1.5 to 1.8) were significantly more common closer to disease onset. Infection and work stressors are potential triggers for the onset of AS; however, low rates suggest they are only a small part of the environmental milieu that combines with a genetic predisposition to cause the development of this chronic inflammatory disease.

Nonsteroidal anti-inflammatory drug use in ankylosing spondylitis--a population-based survey.

The objective of the study is to describe the use, clinical efficacy, and toxicity of nonsteroidal anti-inflammatory drug (NSAID) therapy in patients with ankylosing spondylitis (AS). A cross-sectional population study of 1,080 AS patients was carried out by a written questionnaire in the year 2000. Seventy-eight percent of AS patients had regularly taken NSAIDs for their disease 12 months prior to the study. Most AS patients commonly used diclofenac, naproxen and indomethacin. AS patients were generally rather satisfied with the efficacy of their therapy where 19.1% reported complete pain control, 26.8% reported pain reduction to one quarter, and a further 34.4% reported pain reduction to one half. However, over 20% of patients taking NSAIDs still reported insufficient pain control and more than 40% changed the NSAID due to lack of efficacy. One quarter of AS patients reported severe side effects from their treatment, most commonly abdominal pain, headache and dizziness, and nausea. There was no effect on age or duration of disease on the occurrence of NSAID-related side effects. Medications were commonly ceased or changed due to inefficacy or side effects. The percentage of AS patients reporting changing their NSAID due to side effects ranged from 10.5% for celecoxib to 31.4% for indomethacin. We conclude that NSAIDs are effective in the management of inflammatory symptoms of many, but not all, patients with AS. There is a significant side effect profile, which frequently results in medication change or cessation. Anti-tumor necrosis factor therapy may reduce the need for intensive long-term NSAID therapy in AS.

The high prevalence of infections and allergic symptoms in patients with ankylosing spondylitis is associated with clinical symptoms.

Ankylosing spondylitis (AS) is strongly associated with the major histocompatibility complex (MHC) class I antigen HLA-B27. This may have influence on the physiologic immune response. Whether it leads to an increased prevalence of infections and/or allergy in AS patients is unclear. This study aims to determine the prevalence of infections and allergic symptoms in patients with AS and to detect a possible association with clinical symptoms. Data on 1,080 AS patients and on 102 disc prolapse patients were collected by questionnaire. The proportion of patients with a symptomatic infection in the last year was 65.5% in AS patients in comparison with 25.5% in disc prolapse patients (p=0.0001). AS patients reported more gastrointestinal (GI) [odds ratio (OR) 5.07, 95% confidence interval (CI) 2.20-11.71], urinary tract (OR 2.81, 95%CI 1.41-5.72), and respiratory (OR 5.83, 95%CI 3.38-10.08) infections than did disc prolapse patients. Multiple infections were more common in AS patients across all infection types. Allergic symptoms were reported by AS patients more frequently than by disc prolapse patients (OR 5.13, 95%CI 3.49-8.80). Patients reporting concurrent inflammatory bowel disease were more likely to report GI (OR 3.0, 95%CI 1.9-4.8) and urinary tract (OR 1.7, 95%CI 1-2.8) infection than primary AS patients. In AS patients, infection was independently associated with female gender (OR 1.96, 95%CI 1.47-2.56), a history of significant peripheral joint inflammation (OR 1.55, 95%CI 1.18-2.05), and increasing pain duration (p=0.05). A high prevalence of common infections and allergic symptoms is seen in patients with AS, most of which are HLA-B27-positive. This may have implications both for underlying mechanisms of disease and for therapeutic options.