ankylosing spondylitis prostatitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Ankylosing Spondylitis (AS) is a chronic inflammatory form of arthritis characterized by pain and progressive stiffness.

It is part of a group of rheumatic diseases termed seronegative spondyloarthropathies (vertebral joints) that share the human antigen HLA-B27. AS is “seronegative” (serum negative) because a rheumatoid factor is not detected in the patient's blood (serum).

AS is considered to be hereditary, although environmental factors have been suggested. Most people with the HLA-B27 antigen do not develop AS. It is known to affect white males about four times as often as females. Onset typically occurs between the ages of 15 and 45.

In the early stages of the disease, the sacroiliac joints (back of the pelvis) become inflamed and painful. As the disease progresses, ossification is triggered by the body's defense mechanism. Ossification causes new bone to grow between vertebrae eventually fusing them together increasing the risk for fracture. Further, ossification may affect spinal ligaments causing spinal canal stenosis (narrowing), which can result in neurologic deficit.

• Low back pain that may spread down into the buttocks and thighs. Pain varies in intensity, duration, and is episodic. Stiffness is usually worse in the morning and improves with exercise.

• Limited motion in the lumbar spine.

• As the disease progresses, the patient may notice the discomfort moves up the spine.

• The thoracic region may be affected by pain, stiffness, and limited chest expansion.

• Pain, tenderness, and stiffness in the shoulders, hips, knees, and heels.

• Cauda Equina Syndrome (specific nerve compression) may develop causing bilateral lower extremity numbness, weakness, and incontinence.

• Inflammation of the intervertebral disc or disc space (spondylodiscitis) is a common complication caused by the hardening/thickening of fibrous tissue (sclerosis) affecting vertebral end plates. The resultant abnormal vertebral motion almost always causes pain.

• Spinal deformity: kyphosis (humpback), lordosis (swayback).

The association of AS with bacterial infection is an intriguing one. While the bowel is considered to be a primary site of entry, the site of the bacterial trigger for AS is not necessarily always the bowel. An association between AS and chronic bacterial prostatitis has long been observed. The incidence of chronic prostatitis in male AS patients was 83%, compared to 33% in patients with rheumatoid arthritis. (Mason RM et al. BMJ 1958; 1: 748 ) This association was confirmed in a later study. (Mason RM et al. Rheum Phys Med 1971; 1: 78)

The fact that the prostate may harbor a bacteria which contributes to AS could explain the higher incidence of this disorder in males.

J Clin Microbiol. 1981 May; 13(5): 880–881.
Ankylosing spondylitis associated with Trichomonas vaginalis infection.
T T Kuberski

Abstract

A patient is described who developed signs and symptoms of ankylosing spondylitis after prostatitis due to Trichomonas vaginalis. Chronic prostatitis of unknown cause had previously been reported as being common in patients with ankylosing spondylitis. The observations in this case raise the possibility that T. vaginalis might play a role in the prostatitis and pathogenesis of ankylosing spondylitis in some patients.

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Ankylosing spondylitis prostatitis