Ankylosing Spondylitis

Words: Dr Rajgopal NIDAMBOOR

Ankylosing spondylitis [AS] refers, or relates, to inflammatory arthritis of the spine and other joints. It also reminds one of the bony pangs of rheumatoid arthritis [RA] — which may sometimes progress to bony ankylosis [stiffening, or fixation, of the joint due to the disease process], along with the formation of a ‘lip-like’ structure of the vertebral margins. While the disorder is more common in men, it is often diagnosed by the existence of HLA B27 [human lymphocyte antigen], in the absence of the rheumatoid factor.

Pronounced, ankle-low-zing spond-ill-eye-tiss, AS causes pain, and stiffness, in the back and also bent posture — primarily on account of swelling and irritation of the spinal joints, or vertebra. The condition may eventually make the vertebrae ‘fuse’ together, along with inflammation of the tendons and ligaments that connect and provide support to the joints. This may lead to pain and tenderness [sensitivity] in the ribs, shoulder blade, hip, thigh, shin, heel, and the spine.

One characteristic feature of the disorder is the involvement of the joints at the base of the spine, where the spine joins the pelvis.

The course of the disorder is highly variable.

Symptoms & Signs

  • Frequent low back pain
  • Back stiffness that lasts longer than half-hour in the morning, or following a long period of rest
  • Pain and tenderness in the ribs, shoulder blade, hips, thigh, shin, heel and along the bony projections of the spine
  • There may be mild fever, in the early stages, with loss of appetite and general disquiet
  • Eyes may also be affected; symptoms include eye pain, watery discharge, redness, blurred vision and sensitivity to bright light.

This is how AS emerges — a classical early-morning stiffness and pain in your lower back that gets better, or reduces, during the day with exercise, or when you get into your regular routine.

When pain has persisted for more than three months, it could suggest that the problem may be more than just a simple ‘wear and tear’ in your back. The possibility is — you could be suffering from ankylosing spondylitis.

AS typically affects individuals between age 15 and 30. It is not unusual for the condition to manifest after age 40.

The exact cause of AS is, paradoxically, unknown. Research suggests that there could be a strong link of AS being genetically inherited, especially in the presence of human lymphocyte antigens [HLA] in 90 per cent of individuals presenting with the condition.

AS is suggested to be an ‘autoimmune disorder,’ yes — where the body’s own immune cells damage the joints of the spine. This causes the swelling between your vertebrae and the joints, while involving your spine and pelvis. Pain and stiffness are the first symptoms — they are usually felt in the lower back and upper buttocks. While the spine and the neck may also be affected, in certain advanced cases of SA, where ‘fusion’ of the spine has taken place, there may also be a complete loss of mobility. The whole area becomes brittle and vulnerable for fracture. The spine may also become inflexible [‘bamboo spine’] — this makes standing and walking difficult for the AS individual.

At times, AS may herald the development of inflammatory bowel disease [IBD]. Besides, certain AS patients may present with fever, fatigue, weight loss, anaemia and inflammation of the eye [iritis], while severe cases of AS may have heart valve dysfunction.

While early, appropriate diagnosis and appropriate therapy may minimise pain and disability, it is imperative that rehabilitation measures are promulgated for better treatment outcomes. Proper sleep and walking positions are a must, as also abdominal and back exercises — to maintain good posture. While physical workouts could assist in joint flexibility, breathing exercises enhance lung capacity, just as much as swimming provides for the optimal aerobic exercise effect. Continuing supportive care is critical. This is because AS is generally a lifelong problem. When AS patients fail to follow, or continue, regular treatment, there is an imminent danger — permanent posture and mobility loss.

Treatment 

Ayurveda

Ankylosing spondylitis [AS] is a rheumatic disease with various skeletal and extra-skeletal manifestations. No satisfactory treatment is available in modern medicine for this disorder. Various panchakarma procedures and Ayurvedic drugs have proved to be useful for such manifestations.

We present a case of AS, which was treated for two months with a combination of panchakarma procedures and Ayurvedic drugs. Ayurvedic treatment, in this case, was directed towards alleviating the symptoms and to reducing severe disability.

The patient was considered suffering from asthimajja gata vata [a disorder involving bone and bone marrow] and treated with shalishastika pinda svedana [sudation with medicated cooked bolus of rice] for one month and mustadi yapana basti [enema with medicated milk] with anuvasana [enema with ashvagandha oil] for 30 days, along with oral Ayurvedic drugs for two months. Pratimarsha nasya [nasal drops] with Anu Taila [oil] for one month was given after the completion of the Basti procedure.

The patient’s condition was assessed for symptoms of asthimajja gata vata. The core sets on Assessment of Spondylo Arthritis International Society showed substantial improvement. This study also shows that cases of AS may be successfully managed with Ayurvedic treatment.

  • Sarvesh Kumar Singha, Kshipra Rajoriab, “Ayurvedic Approach for Management of Ankylosing Spondylitis: A Case Report,” J Ayurveda Integr Med, 2016 Mar; 7[1]: 53–56. 

Homeopathy

Research suggests that homeopathic remedies are customarily safe and effective in most chronic and autoimmune disorders, like AS, thanks to their refined bioenergetic therapeutic action, and also for correcting the out-of-sync immune system. Constitutional homeopathic treatment, under the guidance of a professional homeopath, is, of course, imperative for safe, effective, long-term results.

Homeopathic treatment is most effective when it is promulgated well in time. This is primarily because homoeopathic remedies work by optimising the body’s overactive immune [defence] system and bringing them back to normal quickly, more so in the early stages — when AS is not far too gone, or caused irretrievable organic changes.

The stage of SA where homeopathic treatment is initiated is a major factor in determining effective outcomes of treatment. For example, if treatment is started in the initial stages, when not too much of elastic tissue is lost, the prognosis is good — besides, the condition could be reversed to the extent possible. However, when extensive bone ‘formation’ has ‘remodelled’ the elastic tissue, homeopathic remedies may not be able to reverse the situation — although they may be used to easing the most distressing AS symptoms.

Nutrition

Objective. To study the effect of supplementation with omega-3 fatty acids on disease variables and drug consumption in patients with ankylosing spondylitis [AS].

Methods. Twenty-four patients were randomised to either a low-dose [1.95gm omega-3/day] or a high-dose [4.55gm omega-3/day] supplement. Disease activity, functional impairment, erythrocyte sedimentation rate [ESR], and drug consumption were assessed during visits at baseline and at weeks 7, 14, and 21.

Results. Eighteen patients completed the study, nine patients from each group. The patients in the high-dose group exhibited a significant decrease in disease activity according to the Bath Ankylosing Disease Activity Index [BASDAI; p = 0.038], which was not seen in the low-dose group. Significant differences were not found on drug consumption, or in functional capacity in either of the groups. No significant differences were found when comparing the results between the high- and low-dose groups.

Conclusion. Omega-3 fatty acids in adequate doses may have the capacity to decrease the disease activity of AS.

  • B Sundström, K Stålnacke, L Hagfors, G Johansson, “Supplementation of Omega-3 Fatty Acids in Patients with Ankylosing Spondylitis,” Scand J Rheumatol, 2006 Sep-Oct;35[5]:359-62.
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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