“Having a high BMI increases the risk of developing several rheumatic diseases, but the risk is not the same for everyone.”

A recent study from Uppsala University indicates that having a higher body mass index (BMI) can raise the risk of developing five different rheumatic diseases: rheumatism, osteoarthritis, gout, psoriatic arthritis, and inflammatory spondylitis. The researchers also observed that BMI posed a more significant risk factor for women in terms of gout and psoriatic arthritis, compared to men. The study will be featured in the journal Arthritis & Rheumatology.

“Understanding the risks associated with rheumatic diseases can help show that maintaining a lower body weight may be an effective intervention to reduce the risk of developing these conditions,” explained Weronica Ek, a Docent and Researcher at the Department of Immunology, Genetics, and Pathology at Uppsala University, who led the study. “Most rheumatic diseases are driven by inf…”Most rheumatic diseases are driven by inflammation in the body and mainly affect joints, muscles and bones, but vital organs and vessels can also be affected. Symptoms of rheumatic disease can include fatigue, swelling and pain in the joints, stiffness and reduced movement function.

Previous studies have revealed a link between rheumatic diseases and a high BMI, which is a measure that adjusts body weight according to the individual’s height. However, it has not been thoroughly explored whether this connection is a result of high BMI causing rheumatic disease, or if patients with rheumatic disease simply tend to have a higher BMI due to other unidentified reasons. This issue is frequently encountered in epidemiological studies that rely on observational data.

“The researchers in a recent study attempted to address the issue by utilizing information found in human genes. They focused on specific genetic variants linked to a high BMI and found that individuals with a genetic predisposition to higher BMI are at a greater risk of developing rheumatic disease.”“Although we have seen this connection in the past, it is difficult to identify the causal relations between BMI and disease. But when we found that the genes linked to high BMI were also associated with a higher risk of these rheumatic diseases, we were able to conclude that BMI truly does have an impact on the risk of developing rheumatic disease,” notes Ek.

The researchers employed the genetic method called Mendelian randomization to investigate differences between men and women. They also explored potential variations in how BMI impacts the risk for women of childbearing age compared to those who have undergone menopause.

“For both gout and psoriatic arthritis, which are common diseases in patients with psoriasis, we found that a high BMI was a stronger risk factor for women than for men. We also observed that the impact of BMI on the risk of developing osteoarthritis was lower in post-menopausal women compared to women of childbearing age,” explained Fatemeh Hadizadeh, Postdoctoral Fellow at the Department of Immunology, Genetics and Pathology, Uppsala University, and one of the main authors of the study.

The researchers also found that a certain increase in BMI did not result in an equal increase in the risk of developing gout among individuals with low, normal and high BMI.

“We observed that an increase in BMI among individuals with a normal weight led to a significantly higher relative increase in the risk of developing gout compared to an increase in BMI among individuals who are already overweight or obese. This implies that the risk does not increase as much for those who are already overweight. However, it’s important to note that the basic risk of developing gout is always higher with a higher BMI. These non-linear effects are intriguing from a molecular biological perspective and can help us understand the underlying mechanisms behind the increased disease risk associated with higher body weight,” explains Torgny Karlsson, a Statistician at the Department of Immunology, Genetics, and Pathology at Uppsala University and one of the lead authors of the study.

Ankylosing spondylitis – what is it and why it is important you know!




Ankylosing spondylitis

Ankylosing spondylitis

Ankylosing spondylitis (AS) is a long-term (chronic) condition in which the spine and other areas of the body become inflamed.




AS tends to first develop in teenagers and young adults. It’s also around three times more common in men than in women.

Symptoms of ankylosing spondylitis

The symptoms of AS can vary, but usually involve:

back pain and stiffness

pain and swelling in other parts of the body – caused by inflammation of the joints (arthritis) and inflammation where a tendon joins a bone (enthesitis)

extreme tiredness (fatigue)

These symptoms tend to develop gradually, usually over several months or years, and may come and go over time.

In some people the condition gets better with time, but for others it can get slowly worse.

Read about symptoms of ankylosing spondylitis.

When to seek medical advice

You should see your GP if you have persistent symptoms of AS.

If your GP thinks you may have the condition, they should refer you to a specialist in conditions affecting muscles and joints (rheumatologist) for further tests and any necessary treatment.




Further tests may include blood tests and imaging tests.

Read about diagnosing ankylosing spondylitis.

Causes of ankylosing spondylitis

It’s not known what causes the condition, but there’s thought to be a link with a particular gene known as HLA-B27.

Read about the causes of ankylosing spondylitis.

Treating ankylosing spondylitis

There’s no cure for AS and it’s not possible to reverse the damage caused by the condition. However, treatment is available to relieve the symptoms and help prevent or delay its progression.

In most cases treatment involves a combination of:

exercises carried out individually or in groups to reduce pain and stiffness

physiotherapy – where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility

medication to help relieve pain and reduce inflammation– such as painkillers, anti-tumour necrosis factor (TNF) medication and other forms of biological therapy

Surgery is sometimes needed to repair significantly damaged joints or correct severe bends in the spine, but this is uncommon.

Read about treating ankylosing spondylitis.

Complications of ankylosing spondylitis

The outlook for AS is highly variable. For some people the condition improves after an initial period of inflammation, whereas for others it can get progressively worse over time.

Around 70-90% of people with AS remain fully independent or minimally disabled in the long term.

However, some people eventually become severely disabled as a result of the bones in their spine fusing in a fixed position and damage to other joints, such as the hips or knees.

With modern treatments, AS doesn’t normally affect life expectancy significantly, although the condition is associated with an increased risk of other potentially life-threatening problems.

For example, AS can lead to:

weakening of the bones (osteoporosis)

spinal fractures

cardiovascular disease – a group of conditions affecting the heart and blood vessels

chest infections

rarely, kidney disease

Read about the complications of ankylosing spondylitis.

Ankylosing spondylitis – is there genetic cause?




Ankylosing spondylitis

Ankylosing spondylitis

New hope has been offered for sufferers of spine disease following the discovery of two genes that increase the risk of a particular spinal condition, reported The Daily Telegraph. This breakthrough “could help tens of thousands of people in Britain who are victims of the condition ankylosing spondylitis, which causes inflammation in the joints between the vertebrae and can lead to bone erosion and the fusion of the bones in the spine,” the newspaper said.




The Independent reported that these genes have already been linked to the bowel condition, Crohn’s disease and that a “treatment for Crohn’s disease that inhibits the activity of this gene is already in development. If it is shown to be safe and effective it is also likely to help those with ankylosing spondylitis”.

The stories are based on the findings of a large genome-wide association study. However, it is not actually yet certain if the findings will have an implication for treatment.

Where did the story come from?

This study was conducted by members of the Wellcome Trust Case Control Consortium and the Australo-Anglo-American Spondylitis Consortium and was supported by the Wellcome Trust. It was published in the peer-reviewed medical journal Nature Genetics.

 

What kind of scientific study was this?

This was a genome-wide association study which looked at the DNA sequence of a large number of individuals with specific diseases, including ankylosing spondylitis, multiple sclerosis, breast cancer, and autoimmune thyroid disease.

 

There were several different elements to the study. The researchers used complex methods to see how common particular variations within the DNA were in people with one of these diseases. They then compared the variations they found, first with 1,500 healthy British individuals (the control group) and then with the healthy individuals plus those in the other three disease groups. This second analysis provided a bigger group of “controls” to compare the cases with. To confirm the findings of this part of the study, the researchers then compared the variations they found with a new group of 471 people from North America who had ankylosing spondylitis and a new group of 625 healthy North Americans.

As a further part to the study, the researchers looked at a particular variation in a gene called IL23R which has been linked to ankylosing spondylitis in other studies (though it didn’t appear to be in this one). They reanalysed their data (comparing the cases to the combined group of controls) to see whether there was an association between the variation in this gene and the disease.




What were the results of the study?

Across all of their analyses, the researchers found many gene variations that were associated with these diseases. In particular, the newspapers noticed the finding that variations in two genes (ARTS1 and IL23R) had strong links with ankylosing spondylitis, that is, they were more common in people who had this disease compared with those who were healthy or had another disease.

 

What interpretations did the researchers draw from these results?

The researchers concluded that their findings show that variations in these two genes increase the risk of ankylosing spondylitis. They discuss the evidence that variations in one of these genes have already been linked to Crohn’s disease and psoriasis, and that this may partly explain the reason why these diseases often occur together. They say that treatments that target this gene may prove effective for ankylosing spondylitis; however, they call for more research to understand the “mechanism which underlies the observed association”.

What does the NHS Knowledge Service make of this study?

This study reports reliable scientific research and raises some issues that will be of interest to the genetic research community:

The causes of the diseases being investigated are complex. Ankylosing spondylitis is one of a group of related conditions known as the spondyloarthropathies, which are characterised by inflammation involving the joints, tendons and ligaments of, in particular, the lower back, but also other joints such as fingers and toes. These diseases also commonly cause problems other than joint involvement, such as eye conditions or skin rashes. Arthritis associated with psoriasis and with inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis) is included in this group. For a long time, the spondyloarthropathies have all been known to have strong links to the gene HLA-B27. Therefore, it is not surprising that there may be other possible genetic links between these diseases, as this study suggests. However, there are likely to be many other genetic and non-genetic links that remain to be identified. As the researchers themselves highlight, they may have missed further real associations between other variants and the diseases.

The variations on the two genes of interest here – ARTS1 and IL23R – are not unique to people with ankylosing spondylitis and also occur in large numbers of healthy people. Having the variation does not mean you will have the disease.

It is also important to note that readers of the newspapers should not misinterpret the headlines of “arthritis treatment hope” or “hope for spine disease sufferers” and confuse the disease that this research relates to with the much more common conditions of mechanical lower back pain or osteoarthritis.

It isn’t possible to say whether there will be any implications for the treatment of ankylosing spondylitis from these findings. However, the link between IL23R and the disease is an exciting one considering that the research into treatments for Crohn’s disease, which targets this gene, is quite far advanced.

Ankylosing spondylitis (AS) – what to look for if you think you might have ankylosing spondylitis?




Ankylosing spondylitis

Ankylosing spondylitis




Symptoms of ankylosing spondylitis (AS)

The symptoms of ankylosing spondylitis (AS) usually develop slowly over several months or years. The symptoms may come and go, and improve or get worse, over many years.

AS usually first starts to develop during the later teenage years or early adulthood.

The main symptoms of AS are described below, although you may not develop all of these if you have the condition.

Back pain and stiffness

Back pain and stiffness are usually the main symptoms of AS. You may find:

the pain gets better with exercise, but doesn’t improve or gets worse with rest

the pain and stiffness is worse in the morning and at night – you may wake up regularly during the night because of the pain

you have pain in the area around your buttocks

Arthritis

As well as causing symptoms in your back and spine, AS can also cause inflammation of the joints (arthritis) in other parts of your body, such as your hips and knees.




The main symptoms associated with arthritis are:

pain on moving the affected joint

tenderness when the affected joint is examined

swelling and warmth in the affected area

Enthesitis

Enthesitis is painful inflammation where a bone is joined to a tendon (a tough cord of tissue that connects muscles to bones) or a ligament (a band of tissue that connects bones to bones).

Common sites for enthesitis are:

at the top of the shin bone

behind the heel (Achilles tendon)

under the heel

where the ribs join the breast bone

If your ribs are affected, you may experience chest pain and find it difficult to expand your chest when breathing deeply.

Fatigue

Fatigue is a common symptom of untreated AS. It can make you feel tired and lacking in energy.

Pain management – Is your pain worse today than it was one year ago?




Pain - is it getting worse?

Pain – is it getting worse?

As you may know by now one of the main objects of this blog is to help provide our readers with a forum which gives support for people who live on a day to day basis.

Of course there are many conditions which cause severe pain such , as rheumatoid arthritis, multiple sclerosis, migraines, POTS, fibromyalgia, cancer and ankylosing spondylitis. But today we are interested in focusing on pain management in general.




We would like to use today’s blog to ask our readers if you feel your pain is worse today than it was a year ago.

Sadly in my case it is much worse.

Also it would be great if you could share how you feel your pain management is working in the comments section below. In particular it would be great if you could tell us why your pain is getting better or worse over the last 12 months.

But before that we would invite you to take part in the poll below.