IntroductionAnkylosing spondylitis (AS) is a long-term rheumatic disease characterized by inflammatory back pain (Khan, 2002). AS, formerly known as Bechterew disease and Marie-Stümpell disease, is of unknown origin, but dysfunction of immune mechanisms is thought to play a crucial role (Braun and van der Heijde 2007). This disease generally affects the sacroiliac joints and the spine, leading to eventual fusion (ankylosing) of the affected joints (Khan 2002 and Zhang et al. 2003). This disease affects up to 0.1 to 1.1% of the Caucasian adult population worldwide. AS patients also experience increased rates of work disability, unemployment (Boonen 2002), and higher mortality rates (Braun and Pincus 2002). Although the exact etiology of AS is unknown, HLA-B27, a rare allele of the HLA-B gene, is found in approximately 90% of patients with the disease, indicating a strong genetic association (Khan 1995). 1 to 2% of individuals carrying the HLA-B27 genotype developed the disease (1995). Erdesz et al. (1997) suggest that several B27 subtypes may be involved in the pathogenesis of spondyloarthritis. Tiwana et al. (2001) suggested that AS results from synergy between HLA-B27 and antigens of the bacterial genus Klebsiella. Sieper et al. (2011) then argued that eliminating the main nutrients of Klebsiella (starches) would reduce the presence of the antigen in the blood and improve musculoskeletal symptoms. However, as Khan (2002) argues, the evidence for a correlation between Klebsiella and AS is so far circumstantial. There is no cure for AS, although treatments and medications can reduce symptoms and pain (Williams et al. 2007). Symptoms appear gradually, starting around age 23 (Feldtkeller et al. 2003). Treatment of c...... middle of paper ......ated reactive AS in the acute phase appears to benefit primarily from continuous treatment with NSAIDs. This is the first study to show a possible disease-modifying effect of continued treatment and warrants further investigation. Following a review of the literature, van den Berg et al. (2012) described how two studies showed that all NSAIDs have moderate to good statistically significant effects on AS activity and pain. Additionally, no signs of NSAID toxicity were found in this review. However, NSAIDs, at certain doses, may cause an increased risk of gastrointestinal (GI) bleeding. This bleeding can be reduced through the use of gastoprotective agents (Zochling et al 2005). Analgesics, such as acetaminophen and opioids, may be considered for pain control in patients in whom NSAIDs are insufficient, contraindicated and/or poorly tolerated (Lewis et al.. 2002)..