Question:

I have suffered from ME for some six years (after gradual onset over two years). I have also suffered from Ankylosing Spondylitis for twenty years. I am thirty two years old.

Ankylosing Spondylitis is a serious rheumatic disorder affecting the spine (and hip joints to a lesser degree). It is usually thought of as affecting mostly men, but probably affects as many women but in a milder form. It can also cause lethargy and depression and is an auto-immune disease (does that sound familiar?).

The problem with having these two conditions is that the recommended treatments oppose each other. For ME one has to rest, and for Ankylosing Spondylitis exercise relives the pain. Before I had ME, a few strenuous swimming sessions per week would keep any pain and stiffness to a minimum. Now I must resort to NSAIDS (non-steroidal anti-inflammatory drugs) - not good for the stomach. Both conditions seem to play off each other to a degree. That is, an ME relapse can accompany an Ankylosing Spondylitis flare up and vice versa.

I would like to know if any readers also suffering from Ankylosing Spondylitis and ME feel they have any particularly helpful advice concerning the management for the two illnesses. I am also interested to find out whether Dr Macintyre could offer any medical advice on the matter.


Reply:
Thank you for writing about your two illnesses. I do not know for certain if there is a link between ME and Ankylosing Spondylitis. However, both conditions may have a genetic predisposition. Another connection that occurs to me is this: Ankylosing Spondylitis may be associated with abnormal bugs in the gut (as may rheumatoid arthritis), and we know that in ME there are frequently gut problems, liver enzyme abnormalities, inefficient digestion and absorption of food. The bowel bug thought to be associated with Ankylosing Spondylitis is Klebsiella (viz - research by Dr Ebringer and colleagues at the Middlesex Hospital).

One professor of rheumatology that I know thinks that in some people with rheumatoid arthritis the underlying problem is an infection by some uncommon bug in the bowel, and maybe also in the joints. I am at present gathering more information for an article about rheumatic conditions (including Ankylosing Spondylitis) and ME for a future 'InterAction'.

You have a problem in management - you will need to find the happy medium in gentle exercise. Swimming will probably still be best, but it does not need to be strenuous. Maybe five minutes gentle swimming twice a week will be enough to prevent pain. A small well-heated pool is best. Enquire if there is a remedial pool at your hospital.

I would be interested to hear from any other reader who has any experience of, or observations about, arthritis and Ankylosing Spondylitis with ME. If you wish your letter to be passed on to the writer of the above letter, please send it to: The Editor, InterAction, ME Action, PO Box 1302, Wells  BA5 2WE.

Dr Ann MacIntyre (ME ACTION)