May 10, 2005

Hyperparathyroidism

I wonder how common Hyperparathyroidism is in AS. The symptoms seemed to fit, but in reality I guess the relationship to AS is weak or non existant (?). I heard that people with AS tend to have high serum levels of calcium, but on further resaerch that appears to be incorrect. .. I will also look into Secondary Hyperparathyroidism

from http://www.emedicine.com/radio/topic356.htm
Secondary Hyperparathyroidism
In most cases, the sequence of events leading to the development of hypersecretion of parathormone is any long-standing osteomalacia. The most common cause is chronic renal insufficiency, such as that in renal polycystic disease or chronic pyelonephritis. Chronic renal insufficiency is accompanied by several biochemical abnormalities that include diminished urinary excretion of phosphate with consequent elevation of serum phosphate levels and elevation in the levels of the calcium-phosphate product. Serum calcium levels tend to be normal, but they may be marginally reduced. The alkaline phosphates are almost always elevated. The hyperphosphatemia and damaged renal parenchyma leads to a reduction of renal production of 1-a-(OH)2D3, or 1,25-dihydroxycholecalciferol (1,25-DHCC). Decreased intestinal absorption of vitamin D follows, which impairs mobilization of calcium from the bones due to PTH resistance.


from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=842146
"ASp is characterized by significantly reduced elimination of hydraxyproline, higher metabolic pool of calcium, lower elimination of calcium in urine and faeces and lower accretion to bone."
[Calcium, phosphorus, hydroxyproline and nitrogen in inflammatory joint diseases], Z Rheumatol. 1977 Jan-Feb;36(1-2):60-72

from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=315611
"Corrected calcemia was also normal in ankylosing spondylitis, but it was significantly higher in polymyalgia rheumatica. Phosphoremia was shown to be normal but alkaline phosphatases were higher than normal in the three groups."
[Changes in blood calcium, phosphorus and alkaline phosphatase levels in rheumatoid polyarthritis and other types of inflammatory rheumatism], Rev Rhum Mal Osteoartic. 1979 Jun;46(6):389-95.

from: http://jama.ama-assn.org/cgi/content/abstract/240/8/759
An attempt was made to determine whether a relationship exists between ankylosing spondylitis (AS) and hyperparathyroidism (HP). Twenty patients with definite AS, studied for biochemical evidence of HP, did not show consistent abnormalities in serum calcium, phosphorus, alkalinephosphatase, or parathyroid hormone levels or in bone-density measurements. Reviewing roentgenograms of 39 patients with HP showed one patient with sacroiliitis, and one of the 28 hyperparathyroid patients tissue-typed as HLA B27-positive. Both AS and HP are independent entities that have no causative or pathological relationship to each other.
Ankylosing spondylitis and hyperparathyroidism, JAMA, August 25, 1978

[Ed: An old study with too few patients. Must have been a poorly executed study as it says there were no consistant abnormalities in alkalinephosphatase. It is however well known now that alkalinephosphatase tends to be raised in A.S.]

from: http://www.ajcn.org/cgi/content/full/79/3/362
"Vitamin D deficiency in adults causes secondary hyperparathyroidism that can precipitate and exacerbate osteoporosis (2, 9, 11). The secondary hyperparathyroidism associated with vitamin D deficiency often maintains the serum calcium concentration within the normal range, but it causes a loss of phosphorus in the urine. This loss results in inadequate serum calcium x phosphorus to promote mineralization of the osteoid in the bone, which in turn results in osteomalacia, ie, nonmineralization of the collagen matrix."

from: http://www.niddk.nih.gov/health/endo/pubs/hyper/hyper.htm
"The parathyroid glands secrete parathyroid hormone (PTH), a substance that helps maintain the correct balance of calcium and phosphorous in the body. PTH regulates release of the calcium from bone, absorption of calcium in the intestine, and excretion of calcium in the urine.

"When the amount of calcium in the blood falls too low, the parathyroid glands secrete just enough PTH to restore the balance. [..]

"If the glands secrete too much hormone, as in hyperparathyroidism, the balance is disrupted: blood calcium rises. This condition of excessive calcium in the blood, called hypercalcemia, is what usually signals the doctor that something may be wrong with the parathyroid glands.[..]

"This excess PTH triggers the release of too much calcium into the bloodstream. The bones may lose calcium, and too much calcium may be absorbed from food. The levels of calcium may increase in the urine, causing kidney stones. PTH also acts to lower blood phosphorous levels by increasing excretion of phosphorus in the urine.[..]

"When symptoms do appear, they are often mild and nonspecific, such as a feeling of weakness and fatigue, depression, or aches and pains. With more severe disease, a person may have a loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, and increased thirst and urination. Patients may have thinning of the bones without symptoms, but with risk of fractures. Increased calcium and phosphorous excretion in the urine may cause kidney stones. Patients with hyperparathyroidism may be more likely to develop peptic ulcers, high blood pressure, and pancreatitis."


Posted by zarkme at 13:16:09 | Permanent Link | Comments (0) |

February 23, 2005

Left Handers have double rate of bowel disorders

=== Left Handers have double rate of bowel disorders ===
The disorders dicussed below relate to auto-immune disorders, and this is not surprising since many (perhaps the majority) of the immune disorders start in the bowel with dysbiosis of the gut flora (infection). This is particularly true of the inflammatory disorders such as reactive arthritis (reiter's syndrome), rheumatoid arthritis, crohn's disease, eczema, allergies, asthma, etc.

quote: from: http://news.bbc.co.uk/2/hi/health/684236.stm
Title: Left-handers' bowel disease danger
Tuesday, 21 March, 2000, 00:59 GMT
"People who are left-handed are twice as likely as right-handers to suffer from bowel disease, claim scientists.

A study of more than 20,000 people in the UK found that the risk of inflammatory bowel disease - usually Crohn's disease or ulcerative colitis - doubled in left-handed people.

Dr Danielle Morris
Although the prevalence of left-handedness in the general population is around one in ten, 21% of the people found to have inflammatory bowel disease were left-handed.

The research, by a team at the Royal Free Hospital and University College Medical School in London, comes after earlier studies showed left-handers are at increased risk of other conditions such as asthma and diabetes. "


This poll of over 100 people with Ankylosing Spondylitis revealed similar findings.. far more left handers than expected at around 15% as of Feb 2005:
http://asdata.no-ip.info/asdata
Posted by zarkme at 15:40:07 | Permanent Link | Comments (0) |

February 15, 2005

links and anthropology

Some good links found today:

A quote by alohaben
From: http://kickas.bctravel.com/ubbthreads/showflat.php?Cat=0&Number=189476

(...) as thor heyerdal used to rankle the anthropologists...could you explain how the peruvian purple potato got to polynesia and new zealand...google umara or kumara...and the trip from peru to tahiti is into the win

Posted by zarkme at 09:37:48 | Permanent Link | Comments (0) |

February 09, 2005

Diagnosis and Disease Impact

thanks to evelyn for posting this here
==========================

LEADER
Barkham N, Marzo-Ortega H, McGonagle D, Emery P.
How to diagnose axial spondyloarthropathy early
Ann Rheum Dis. 2004 May;63(5):471-2. No abstract available.
medline link
full text link

A proposed algorithmic approach may be useful in the early detection of AS

Keywords: ankylosing spondylitis; spondyloarthropathy; early diagnosis; back pain; prediction

Physicians’ perceptions of the spondyloarthropathies are changing. Ankylosing spondylitis (AS), the prototype of this group, has traditionally been considered a rare disease with few therapeutic options. In addition, diagnosis is difficult, sometimes delayed for decades, mainly owing to the lack of sensitivity of the traditional imaging method, radiography, to detect the hallmark of AS, sacroiliitis. Also, the widespread perception of these diseases as "innocuous" or having a good outcome has hampered the development of protocols for defining early disease and identifying those patients who would benefit from early treatment.

PROBLEMS OF AS

It is now clear that these assumptions are incorrect. Ankylosing spondylitis is more common than previously estimated, with some studies suggesting a prevalence as high as 1%.1 Importantly it affects people at a time when they are economically active (most commonly in the third decade), and the disease has a major impact on a person’s ability to work. Recent evidence from a survey from our group shows that a high proportion of patients with AS still in work have major problems suggesting imminent job loss.2 In addition, the assumption of a good clinical outcome has recently been challenged, with 70% of patients progressing to fusion of the spine by 10–15 years.3,4 Mortality is also increased by 1.5–4 times that of the general population,5and a 12% decrease in survival over 40 years has been noted.6
Posted by zarkme at 14:37:26 | Permanent Link | Comments (0) |