the Causes of Ankylosing Spondylitis: Is It Genetic or Lifestyle?

I would like to inquire about the causes of ankylosing spondylitis?

Dear Doctor,
Three years ago, I experienced tightness and discomfort in my upper back, and after being evaluated by two physicians, I was diagnosed with ankylosing spondylitis (AS).
X-rays were taken, and I tested positive for HLA-B27.
Currently, my back pain has subsided, so I have not continued taking medication (Secukinumab).

I have always struggled to understand why I developed this condition, especially since there is no family history.
It wasn't until a rheumatologist mentioned to me, "Don't mess around with free girls," that I started to reflect on my personal life.
Between 2018 and 2020, I had a very unstable number of sexual partners, totaling over 30, and I did not consistently use condoms.
I was diagnosed with AS in October 2018.
I would like to ask the doctor if having multiple sexual partners and engaging in risky sexual behavior could be a primary cause of ankylosing spondylitis, or if AS is primarily a genetic issue (HLA-B27 positive) that I would have developed regardless.
I appreciate your clarification on this matter.

Kai, 20~29 year old female. Ask Date: 2021/09/25

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
Here are my responses to your questions:
1.
Could multiple sexual partners and risky behaviors be the main causes of ankylosing spondylitis? --> I believe the physician who is concerned about your private life may suspect that your symptoms of ankylosing spondylitis resemble those of reactive arthritis, which is also an inflammatory spondyloarthritis.
The latter is associated with infections, particularly sexually transmitted infections.
However, even though efforts are made to differentiate between these two conditions, the subsequent treatment remains similar.
2.
Is ankylosing spondylitis a genetic issue (HLA-B27 positive) that one will inevitably develop sooner or later? --> The majority of cases of ankylosing spondylitis, over 90%, are associated with the HLA-B27 gene.
However, having this gene does not guarantee that one will develop the disease in the future.
Generally, when an individual with ankylosing spondylitis possesses this gene, the likelihood of their children also having the gene increases the chances of them developing the disease.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/09/25

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It is classified as a type of spondyloarthritis and is closely associated with the HLA-B27 antigen. Understanding the causes of AS involves examining both genetic and environmental factors.

Firstly, genetics play a significant role in the development of AS. The presence of the HLA-B27 antigen is a strong genetic marker associated with the disease. Studies have shown that individuals who test positive for HLA-B27 have a higher risk of developing AS compared to those who do not carry this antigen. However, it is essential to note that not everyone with HLA-B27 will develop AS; in fact, only about 5-10% of individuals with this antigen will go on to develop the disease. This indicates that while genetics is a critical factor, it is not the sole determinant.

On the other hand, environmental factors, including lifestyle choices and infections, may also contribute to the onset of AS. Some researchers suggest that certain infections, particularly those caused by bacteria, may trigger an autoimmune response in genetically predisposed individuals. This means that while you may have the genetic predisposition due to HLA-B27, an environmental trigger could potentially initiate the disease process.

Regarding your concerns about multiple sexual partners and risky behavior, it is crucial to clarify that while these factors can increase the risk of sexually transmitted infections (STIs), there is no direct evidence linking them to the development of AS. However, some infections, such as those caused by Chlamydia or other pathogens, have been proposed as potential triggers for spondyloarthritis in susceptible individuals. Thus, while your lifestyle choices may not directly cause AS, they could contribute to infections that might play a role in triggering the disease in someone who is genetically predisposed.

In summary, Ankylosing Spondylitis is primarily influenced by genetic factors, particularly the presence of the HLA-B27 antigen. However, environmental factors, including infections and possibly lifestyle choices, may also play a role in the disease's onset. It is essential to maintain a healthy lifestyle, manage stress, and seek regular medical advice to monitor your condition. If you have concerns about your sexual health or potential infections, discussing these with your healthcare provider can help you make informed decisions about your health and well-being.

In your case, since you have already been diagnosed with AS and are HLA-B27 positive, it is advisable to continue monitoring your symptoms and maintain a dialogue with your healthcare provider. They can help you manage your condition effectively and address any concerns you may have about lifestyle factors and their potential impact on your health.

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