I chose to immediately write on this topic. An old patient of mine walks in and complains of a back pain. he suffers from IBD (inflammatory bowel disease).

First IBD. in this condition, Diarrhea is a common presentation . Prolonged diarrhea without bleeding but with other features suggestive of inflammatory bowel disease (IBD). Two major forms of this disease are ulcerative colitis (UC) and Crohn disease (CD). Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon while Crohn disease is characterized by transmural inflammation and by skip lesions.

Some risk factors could be:

  • Age and gender
  • Racial and ethnicity
  • Genetic susceptibility
  • Smoking
  • Diet
  • Physical activity
  • Obesity
  • Infections

spondyloarthritis (SpA, formerly spondyloarthropathy) is often referred to a group of disorders that includes ankylosing ( Causing immobility to the joins) spondylitis  or called as (AS). The main forms could be undifferentiated spondyloarthritis (USpA), reactive arthritis (ReA), and the arthritis and spondylitis that may accompany psoriasis and inflammatory bowel diseases (IBD).

How is IBD linked to AS.  Gastrointestinal (GI) tract, is There is a strong and well-established association of human leukocyte antigen (HLA)-B27 with ankylosing spondylitis (AS).

I can see of the Labstestsonline that, “With new genetic testing methods, it is now possible to separate HLA-B27 into subtypes. So far, more than 70 different subtypes have been identified, such as HLA B27*05 and HLA B27*02. How the presence of these specific subtypes affects the likelihood of developing an autoimmune disease is not yet known.”

Approximately 90 percent of the risk of developing AS is heritable. At least 30 gene loci have been discovered. The largest contribution is the human leukocyte antigen (HLA)-B27 molecule.

1 comment

  1. Now this patient came back and his CRP and blood sugar fasting was in normal range. Advise was as under:

    All doctors may have a different take on the current condition you are in and the tests for which we have the reports now. My inference is as under:

    I see that the blood sugar fasting is 94. The reference range the lab considers is 70-100. In case one has to explore diabetes a better test is HbA1C. This looks at the blood sugar levels over the past 3-4 months and not a random like this one. However , I do not consider this as a pre-diabetic either. In case you must have eaten less one night before I consider this as an incorrect reading. You may consider HbA1C test in case you are directed towards taking an initial drug for diabetes (metformin), else just let it remain as is and do not worry.

    ESR is normal, hence I don’t think you have an infection. Now for CRP, traditionally, this is elevated in Rheumatic fever, Rheumatic arthritis, myocardial infarction(heart attack), cancer, bacterial or viral infections.

    Connection between CRP and ESR is that CRP rises before the ESR rises and then comes down. As ESR is not high CRP may not have a relevance.

    Now for the HLA B 27, as I had shared earliest the doctor is trying to investigate AS (arthrospondylitis) and others like the report states as Reiters syndrome (this is nothing but the Reactive arthritis, I am sorry to state they treat this as a diffrenet condition but the other labs worldwide and medical fraternity does not ), Reactive arthritis (due to microorganisms such as Yersinia, Salmonella, Shigella & Chlamydia), Acute anterior uveitis (a condition of the eye), Psoriatic spondylitis (arthritis with scaling of the skin as in psoriasis). You may be given some antivirals and antibiotics to fight the condition. May be some more for GUT infection as some feel it is.

    Each plus means a likelihood to contract and not a positive report that a patient has all these conditions. A chance as they say it is.

    Now for the low back pain, my overview is as under:

    In AS the pain is more severe in the morning or after a period of rest and nor relieved by rest or sprain in the lumbosacral region.

    Please see the doctor and see what he states and discuss if you want later.


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