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Does the Microbiome Cause Ankylosing Spondylitis?

SAA Medical Board Member James Rosenbaum, MD, posed this question in SAA's news magazine, Spondylitis Plus. Since that article was published, SAA has assisted in funding his research to test his hypothesis.

Abstracts

Prevalence of AS & Online Screening Tool in the USA

The concept of inflammatory back pain (IBP) evolved in the 1970s, coincident with the discovery of the HLA-B27 association with ankylosing spondylitis (AS), leading to the development of criteria to determine the presence of IBP. The concept of IBP and it relationship with AS and axial spondyloarthritis (AxSpA) has further evolved, and an instrument developed (the Spondylitis Association of America Back Pain Tool), which was further modified and field tested for use in the 2009-2010 National Health and Nutrition Examination Survey (NHANES). This has shown the frequency of chronic back pain to have risen to 19.4%, with nearly one-third having IBP. The prevalence of AxSpA has been defined at 1.0-1.4% and AS at 0.52-0.55%. The national prevalence of HLA-B27 in the U.S. is 6.1%, and intriguing data from NHANES 2009 suggest a decreasing frequency with increasing age. From this arise new questions and a work agenda ahead.

Genetic and Environmental Influence on SpA Diseases

Dr. Lianne Gensler is a rheumatologist at the University of California, San Francisco (UCSF) Medical Center and the Director of the Ankylosing Spondylitis Clinic. Dr. Gensler, Dr. Matt Stoll and Dr. Matt Brown were selected to receive funding for their MOSAS research study.

Multiple genetic and environmental factors result in the development of SpA diseases, including ankylosing spondylitis. In this study, Dr. Gensler et.al will evaluate children at increased risk of developing spondylitis based upon a family history of AS and positive HLA-B27 marker, comparing them to their HLA-B27 negative, and thus lower-risk siblings as well as to their disease-free parent. This will be the first study of its kind to evaluate the pre-disease microbiota in patients with a higher likelihood of developing arthritis.

Fungus/Yeast in the Pathogenesis of SpA

Drs. Mark Asquith and James Rosenbaum’s research focuses on the potential role for fungus or yeast in the pathogenesis of spondyloarthritis. Microbiota is the community of micro-organisms that inhabit the interior and exterior of the human body at various tissue sites. Drs. Asquith and Rosenbaum’s research utilizes fungal microbiota to investigate a novel therapeutic strategy to reduce or prevent disease symptoms in AS patients. 

Treatment Guidelines

Recommendations for the Management of Axial Spondyloarthritis

The American College of Rheumatology (ACR) has released new recommendations for the treatment of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA). The guideline was developed with the Spondylitis Association of America (SAA) and the Spondyloarthritis Research and Treatment Network. It summarizes recommendations for both pharmacologic and non-pharmacologic treatments, including rehabilitation, management of patients with comorbid conditions, use of certain surgeries, and approaches to patient monitoring.

National Patient Registry on Ankylosing Spondylitis

SAA has seeded a national patient registry on ankylosing spondylitis. By combining three existing patient databases that have been used in research, the composite database can look at thousands and potentially tens of thousands of patients and be able to track health trends, disease severity over time, age, gender, race, and many other factors to improve understanding of the disease.

SAA's Magnetic Resonance Imaging (MRI) Workshop in Spondyloarthritis

Molecular Basis for the Association of HLA-B27 and Ankylosing Spondylitis

The goal of Dr. Taurog's research has been to understand the molecular basis for the association of the rheumatic disease called ankylosing spondylitis with the major histocompatibility allele HLA-B27. This MHC class I allele is found in 7 percent of the U.S. population, but in over 90 percent of individuals with ankylosing spondylitis. Of individuals with B27, it is estimated that up to 13 percent will develop ankylosing spondylitis or a related form of spondyloarthritis.