生活在痛苦和僵硬ankylosing spondylitis (AS)is hard enough. But many people with AS also have to deal with another chronic condition on top of it, one that causes inflammation and irritation in the digestive tract and triggers腹痛,腹泻和其他肠道问题。
“Somewhere around 5 to 10 percent of individuals with AS also have inflammatory bowel disease (IBD), eitherCrohn's diseaseor溃疡性结肠炎，“说Joel Taurog，MD， 一种professor of internal medicine and immunology in the division ofrheumatic diseasesat the University of Texas Southwestern Medical Center in Dallas.
以下是您应该了解AS和IBD之间的连接 - 包括当重要的时候gastrointestinal（GI）症状检查出以及两个条件如何处理。
IBD和强直性脊柱炎：链接是什么？
While a relatively small number of people withankylosing spondylitis最终被诊断出患有克罗恩病或疾病溃疡性结肠炎据John Miller, MD， 一种风湿病学者和instructor of medicine in the division of rheumatology at Johns Hopkins Medicine in Baltimore.
“尽管有很多人没有出现明显的肠道炎症，但也有研究表明，米勒博士解释道。“以及大量患者患有GI症状。我们将这些疾病分开到离散箱中，但我认为有很多重叠。“
消化道中的异常免疫应答似乎在克罗恩病和溃疡性结肠炎中发挥作用。
The immune system is made up of proteins and cells that normally protect against infection. In IBD, the immune system mistakenly attacks harmless or even beneficial cells as if they are harmful invaders. This immune response is believed to cause the chronic inflammation seen in IBD that damages thegastrointestinaltract and causes symptoms.
Miller notes that we currently don’t have a strong understanding of causation when it comes to AS and IBD — whether an altered immune system allows certain bacteria to develop in the GI tract, or whether the growth of certain bacteria leads to an altered immune response in some people. And, in fact, some people develop symptoms of AS in their spine or other joints before they have any GI symptoms, while for others the order is reversed.
But what makes some people more susceptible to both AS and IBD in the first place?
“协会很大程度上是遗传的，”Taurog博士说。“超过一半的30加基因被鉴定为易感基因，也是IBD的易感基因。”
Treating IBD and Ankylosing Spondylitis
对于具有胃肠炎患者的人患有胃肠杆菌或IBD的诊断，医生可能需要一种不同的方法来治疗这种疾病，而不是在没有GI症状的人中。
nsaids谨慎使用
In a person with AS who has GI symptoms, doctors would tend to be more cautious about prescribingnon-steroidal anti-inflammatory drugs (NSAIDs)喜欢aspirin,ibuprofen(Advil or Motrin),Aleve (naproxen)， 和others.
根据米勒，这些药物可能会刺激消化道和恶化的胃肠症状，甚至可能导致新的炎症。
TNF Inhibitors May Help Both IBD and AS
Instead, doctors may be quicker to prescribe biologic drugs called TNF inhibitors in people with AS who have IBD. These drugs can help both conditions by targeting an inflammation-promoting substance called tumor necrosis factor (TNF), which is produced by the immune system.
“Some of the anti-TNF therapies that have currently been approved for Crohn’s disease and ulcerative colitis can be used totreat ankylosing spondylitis，“说Ashwin Ananthakrishnan，MPB，MPH， 一种gastroenterologist at Massachusetts General Hospital in Boston and an assistant professor of medicine at Harvard Medical School.
But not every TNF inhibitor is effective for both conditions, and one drug may be more effective than another in a given person.
Remicade(英夫利昔单抗),Humira (adalimumab),Simponi (golimumab)， 和Cimzia（Certolizumab）are approved as treatments for both AS and IBD.
Dr. Ananthakrishnan says that the dosing of these drugs, in some cases, might ordinarily be different for the two conditions, so it’s important for your风湿病学者和胃肠学家沟通以决定剂量适合您。
Ananthakrishnan notes that getting effective treatment for both AS and IBD that targets the underlying inflammation — including through biologic therapies like TNF inhibitors — may reduce the need for pain medication likeNSAIDs. But for some people, taking an NSAID every now and then as needed doesn’t cause digestive upset or any other problems.
IL-17 Inhibitors Risk Worsening IBD
TNF抑制剂不是可用于治疗的唯一可以用于治疗的生物药物组。另一组称为IL-17抑制剂，包括cosentyx（secukinimab）和taltz（Ixekizumab）.
But these drugs carry a risk for making IBD symptoms worse in people with Crohn’s disease or ulcerative colitis, and may even lead to new cases of IBD.
据Miller表示，对于一些具有IBD或GI症状的人，谁没有IBD或GI症状，并且对TNF抑制剂不响应良好，这可能是一个值得花的风险，根据米勒，根据米勒。
使胃肠道变化s to Your Doctor’s Attention
不管你采取什么治疗的,“这是不rtant to bring up GI symptoms like diarrhea, blood in the stool, orbloating after meals” with your doctor, Miller says.
这适用于您的初始诊断和治疗决策，以及随着时间的推移而发展的任何新症状。而且，不幸的是，新的GI症状通常会在谁中开发。
“如果我们看到新的扫描结果或新的GI症状，这并不完全惊讶，”米勒说。“有时它是第一个人的礼物;有时它是首先出现的GI症状。“
Additional reporting byRegina Boyle Wheeler.
