Hello,

I did not notice gut involvement at first, but that does not mean it was not present and I may not have been observant enough.

One issue with my original AS symptoms is that I was also very athletic and played a lot of basketball... prior to my first AS symptoms, I had basketball injury 1/2 year close to area were I first had AS symptoms (right SI)... so all doctors related one to the other. Injury healed... AS stayed (unfortunantely) and progressed.

Tim

for at least the last 5 years, it has become obvious that my bowels, joints, and everything else flare together. and i've been trying, in vain, to determine which is the chicken and which is the egg.

if and when you ever learn an answer to this mystery, i'd love to know as well!

Sue,
It seems likely that the gut inflammation comes first and triggers a cascade of symptoms, since that's the way it works for reactive arthritis. Here is an animal study from 2010 that showed a mechanism for the inflammation spreading from the gut to the joints:

http://www.sciencedaily.com/releases/2010/06/100617120716.htm

"One surprising finding was that bacteria in the gut could influence the development of an autoimmune disease affecting tissues distant from the gut. Diseases such as irritable bowel syndrome have been linked to gut-residing bacteria, but this study is unique in showing the mechanism by which a bacterium in the gut can influence the development of an autoimmune response that ends in inflammation and pain in the joints."

thanks for that article. it looks familiar, think i've seen it before.

it does make sense, that it would start in the gut.
i still remember, first visit, my rheumatologist saying, "i think all spondyloarthropathies begin in the gut."

and when i found out i did not have any lactobacilli in my gut, despite eating stoneyfield yogurt everyday. and finding out that i had possible pathogenic other bacillus bacteria in my gut. then it made a lot more sense that these "bad" bacteria could be outcompeting my "good" bacteria, and causing problems.

thus, my thinking was if i take probiotics (lactobacillus in particular since it was what i was missing), maybe i could get better that way. or at least it would be an important part of my therapy.

but, there is one thing i still don't understand. and it is the question my rheumy asks every time i go to see him, "what is triggering the flares"? if it is the bacteria in the gut, then why not all the time? why flares? maybe its just a war where sometimes the good part of my immune system wins and sometimes the bad part wins?

but if it really does all start in the gut, then focussing on the gut, makes sense. so will keep that up. though also focussing on the immune system seems to be helping as well.

well, that paper, and others like it, do help illuminate some of this.
but i still have questions.
i guess the logic is, "if we can figure out why we flare, then we can start to prevent those flares."

I started having gut problems prior to having any inflammatory arthritis.
My arthritis really blew up when I got an intestinal sickness in Thailand.
There is no doubt a correlation with myself. And I have taken very little NSAID's in my life. I think they are horrible long term medicines.
the issue is once you have this information what can you do about it? Will healing the gut damp down the arthritis? The "gut" is in essence our immune system.

I also started having gut issues well before any AS symptoms began. I didn't correlate it early enough, but once I understood that the gut is truly the gateway to the immune system, I started to heal the intestinal lining, and my AS and all my joint symptoms decreased!

But its a lifelong route to keeping the gut lining healthy. And eating all my salads, avoiding sugar, taking digestive enzymes and even getting routine colonics has helped, not hindered, my gut health.

But I also exercise regularly as the AS did damage my joints before i got a handle on things. So far i'm doing ok...

had issues of constipation as a kid, remember lots of prune juice

things got better as a teen and in my 20s. on my own i increased my fiber and things got regular. dried fruit and nuts seemed to he a big help.

age 29, IBS started. not fully digesting food. doctors did a workup and ruled out things like parasites, etc through stool sample testing. not sure what else they did. but other than the diarrhea, lack of digesting my food, no other symptoms. on and off for that year or so.

age 30, the gastritis hit. when the gastritis was bad, the IBS followed. i noticed that if i did things to "heal" the stomach, the IBS followed. so i focussed on the stomach. took about a year to get the gastritis partially under control. took 3 years total to having it feel "back to normal".

age 35, the arthritis kicked in. started with enthesitis in the wrists (tendonitis requiring cortisone in one of the wrists, PT for both wrists), upper back issues which now i understand was the bone spurs in my neck kicking in. age 37, the SI joint kicked in, suddenly and dramatically. flared every few months after that. bowels and gastritis also started flaring up again at age 39. since then its been both together.