Klebsiella: The Cause of Rheumatoid Arthritis and Ankylosing Spondylitis, Part 2

Klebsiella: The Cause of Rheumatoid Arthritis and Ankylosing Spondylitis, Part 2

What is Ankylosing Spondylitis?

Ankylosing spondylitis is a chronic Klebsiella infection or inflammation from endotoxins of the axial skeleton and occasionally the joints. Ankylosing spondylitis usually develops from the chronic overgrowth of Klebsiella when one is a young adult, and the symptoms of the disease slowly worsen. Early symptoms of AS include lower back pain, increased curvature of the lower spine, joint pain, stiffness in the lower back, weight loss, fever, and fatigue. Later progression of the disease can cause loss of spinal manipulation, issues with breathing and chest expansion, arthritis in the hips and shoulders, severe pain, and swelling. 1 2

AS is diagnosed from radiological imaging to determine function, sclerosis, and erosion of the spine and joints. Inflammatory markers like C-reactive protein, TNF-a, and interferon gamma may increase during acute phases of heavy overgrowth or active infection of Klebsiella and the HLA-B27 gene may be tested. Human leukocyte antigen genes are essential in the regulation of our immune system in reaction to the world around us, including pathogens. Mutations in HLA-B27 has been discovered to be linked to increased Klebsiella sensitivity from leaky gut and the development of AS. 3 4 5 6

Medication including NSAIDS and opioids to limit pain and biologics including anti-rheumatic drugs, TNF-a blockers, and interleukin-6 inhibitors, are used to try to control symptoms and slow progression of the disease. Physical therapy may help increase the range of motion and relieve pain. Finally, surgery may be needed to the spine, hips, and joints to replace body parts, remove scar tissue, and to try to reduce and relieve pain. 7 8

Klebsiella Overgrowth the Cause of Ankylosing Spondylitis

I mentioned a few clues above that link Klebsiella as being the cause of AS. Is it not weird for an “autoimmune” condition to cause a fever during the acute, painful stage? Here is another coincidence: the same inflammatory markers tested for AS are elevated in Th1 dominant immune conditions what are caused by the Gram-negative bacterium, Klebsiella. Mutations in HLA-B27 distort a proper immune response to Klebsiella overgrowth. The distortion of immune function can allow for easier Klebsiella overgrowth, or can cause improper immune reactions to LPS endotoxins causing Th1 dominance and chronic inflammation in the spine and joints for issues with proper collagen production. Reducing starch in the diet has been demonstrated in studies to reduce Klebsiella populations in the gut and reduce symptoms of AS. Finally, multiple studies have found overgrowth of Klebsiella and increased antibodies to Klebsiella endotoxins in people with AS. 9 10 11 12 13

So why do some people with Klebsiella overgrowth develop just gut issues and some develop AS, what is the difference? We all have Klebsiella in our body as natural flora. Are mutations or epigenetic changes in the gene HLA-B27 and possibly other genes the difference in why someone who takes antibiotics long-term or eats a lot of resistant starch eventually develops AS? It is possible. I will go one step further and say that it is even possible for these genes to mutate epigenetically (mutations that occur from the environment). Could a severe overgrowth of Klebsiella itself change one’s genetics making the body more susceptible to it? Klebsiella endotoxins change the expression of HLA-B27. Klebsiella itself might be able to mutate HLA-B27 so that the immune system fails to recognize and control the pathogen leading to excessive inflammation and Th1 dominance. 14 15 16

Medication that is used in treating AS tackles the symptoms only of the overgrowth but does not reduce it. Opioids help to control the pain that is caused by inflammation and scar tissue caused by the overgrowth. NSAIDS and most biologics hinder the immune system and reduce Th1 dominance which for a time quenches inflammation and reduces damage to the body. However, the Klebsiella overgrowth worsens from being uncontrolled and most people relapse and inflammation increases which override the medications, causing a vicious cycle of inflammation, scar tissue formation, and pain. 17 18

The most damning evidence that AS is caused by Klebsiella is that most people die from cardiovascular symptoms. The cardiovascular system is under constant assault from increased inflammation occurring from Th1 dominance in response to endotoxins produced from Klebsiella, which inflame the arteries, heart, and veins over time. Chronic inflammation from endotoxins produces cardiovascular disease which may eventually lead to heart failure and death. 19 20

Klebsiella overgrowth is the most likely cause of ankylosing spondylitis, or at the very least, Gram-negative bacterial overgrowth and the bodies immune reactions to endotoxins. My next blog post in the series will cover Klebsiella and its relation to rheumatoid arthritis.

See more from this series:

  1. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  2. Bauman, Robert. Microbiology with Diseases by Body System, Benjamin Cummins, September 12, 2012.
  3. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  4. Bauman, Robert. Microbiology with Diseases by Body System, Benjamin Cummins, September 12, 2012.
  5. http://www.discoverymedicine.com/Taha-Rashid/2011/09/12/gut-mediated-and-hla-b27-associated-arthritis-an-emphasis-on-ankylosing-spondylitis-and-crohns-disease-with-a-proposal-for-the-use-of-new-treatment/
  6. http://www.kickas.org/medical/11.shtml
  7. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  8. Bauman, Robert. Microbiology with Diseases by Body System, Benjamin Cummins, September 12, 2012.
  9. http://www.discoverymedicine.com/Taha-Rashid/2011/09/12/gut-mediated-and-hla-b27-associated-arthritis-an-emphasis-on-ankylosing-spondylitis-and-crohns-disease-with-a-proposal-for-the-use-of-new-treatment/
  10. http://www.kickas.org/medical/11.shtml
  11. http://www.ncbi.nlm.nih.gov/pubmed/9973159
  12. http://perfecthealthdiet.com/2014/11/update-attacking-ankylosing-spondylitis-phd/
  13. http://thegutinstitute.com/2014/10/dont-take-raw-potato-starch-rps-temporarily-if-you-have-an-autoimmune-disorder-part-5.html
  14. http://www.discoverymedicine.com/Taha-Rashid/2011/09/12/gut-mediated-and-hla-b27-associated-arthritis-an-emphasis-on-ankylosing-spondylitis-and-crohns-disease-with-a-proposal-for-the-use-of-new-treatment/
  15. http://www.kickas.org/medical/11.shtml
  16. http://www.ncbi.nlm.nih.gov/pubmed/26659265
  17. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  18. Bauman, Robert. Microbiology with Diseases by Body System, Benjamin Cummins, September 12, 2012.
  19. http://emedicine.medscape.com/article/219907-overview
  20. http://www.ncbi.nlm.nih.gov/pubmed/17510602
  1. Does this imply that A.S. is reversible by treating the klebsiella overgrowth and reestablishing balanced flora?

  2. Where is the klebisella that causes AS inflammation primarily located (colon, small intestines, illeum, etc.)?

  3. Oh yeah, quick question: Would sweet rice/glutinous rice (https://en.wikipedia.org/wiki/Glutinous_rice) be better than jasmine rice (well-chewed) for KP overgrowth? It has little to no amylose and high amylopectin. From my limited understanding, that means sweet rice would be better?

  4. Great follow-up article!

    Didn’t know about epigenetic changes/mutations KP can potentially exert on the genome. If that were true, is there any way to reverse them?

    Also, is there a reason AS seems to affect males and certain populations (Asians, Native Americans, Caucasians, etc) more?

    Looking forward to the rest of the series.


    • Possibly by reducing the overgrowth of Gram-negative bacteria, increasing endogenous vitamin D, and reducing Th1 inflammation, the genes can be influenced in a more positive light.

      Probably, genetic weaknesses to the endotoxins per genetic populations.

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