What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) is one of many forms of chronic inflammatory and degenerative arthritis, affecting the spine A.S. especially affects the joints between the vertebrae of the spine and the joints between the spine and the pelvis (sacro-iliac joints). It may also affect other joints of the body. The joints are initially inflamed and this may be followed by progressive stiffness and inflexibility.
It eventually leads to the fusion of the spine, giving permanent painful stiffness of the back. It is often called bamboo spine, as the spine tends get stiff like a bamboo. This condition is more common in males as compared to females and usually occurs in individuals between 16-40 years of age.
Ankylosing spondylitis can briefly be summarized as under:
- Ankylosing spondylitis belongs to a group of arthritis conditions which tend to cause chronic inflammation of the spine as well as degeneration.
- Ankylosing spondylitis is a cause of back pain in adolescents and young adults.
- Tendency to develop Ankylosing spondylitis is genetically inherited.
- The HLA-B27 gene can be detected in the blood of most patients with AS.
- Ankylosing spondylitis can also affect eyes, heart, lungs, and occasionally the kidneys
- The optimal treatment of Ankylosing spondylitis involves medications that reduce inflammation or suppress immunity, physical therapy and exercise.
- Homeopathy offers encouraging results, significant disease control and pain relief.
Site of disease:
The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Due to chronic inflammation in these areas there are symptoms like pain and stiffness of spine. As this condition is chronic one with time this leads to fusion of the vertebrae i.e. complete cementing together of vertebrae.
This process is known as Ankylosis. Due to this condition there is loss of mobility if spine. The stiffness could eventually be very severe making the spine resembling a bamboo. Hence it is also called bamboo spine.
Ankylosing spondylitis can affect other tissues throughout the body. It can cause inflammation in or injury to other joints away from the spine, as well as other organs, such as the eyes, heart, lungs, and kidneys.
- Psoriatic Arthritis
- Reactive Arthritis
- Arthritis associated with Crohn’s disease and ulcerative colitis.
These conditions are collectively referred to as “spondyloarthropathies.”
Causes of Ankylosing Spondylitis
The exact cause of Ankylosing spondylitis is not understood. It has been considered to be an autoimmune disease (like many others such as Diabetes, Rheumatoid Arthritis, Alopecia Areata, Thyroiditis, etc.). Genetic factors are likely to be involved. The majority of people with Ankylosing spondylitis have a gene called HLA-B27. However, the presences of HLA-B27 (Human Leukocyte Antigen B27) is not absolutely diagnostic of AS.
1. Genetic theory:
AS has a strong genetic factor as a cause behind its development. About 90 % of patients with AS are born with HLA B27 gene. There are blood tests to detect HLA-B27 gene marker. The HLA-B27 gene appears only to increase the tendency of developing Ankylosing spondylitis, while some additional factor(s), perhaps environmental, are necessary for the disease to appear or become expressed.
Interestingly, the presence of HLA-B27 alone does not make one prone to develop this disease. As per a study, about 7% of the United States populations have the HLA-B27 gene, only 1% of the population actually has the disease Ankylosing spondylitis.
In Northern Scandinavia (Lapland), 1.8% of the population have Ankylosing spondylitis while 24% of the general population have the HLA-B27 gene. Even among HLA-B27 positive individuals, the risk of developing Ankylosing spondylitis appears to be further related to heredity. In HLA-B27-positive individuals who have relatives with the disease, their risk of developing Ankylosing spondylitis is 12% (six times greater than for those whose relatives do not have Ankylosing spondylitis).
2. Autoimmune theory:
Autoimmunity is considered significantly involved in the development of AS. Again, autoimmunity itself may be genetically oriented.
3. Prolonged stressful situation
Prolonged stressful situation in one’s life could possibly trigger the underlying genetic tendency for AS.
4. Bacterial infections
Bacterial infection triggering AS is one of the other theories.
Current research about Ankylosing Spondylitis:
Recently, two more genes have been identified that are associated with Ankylosing spondylitis. These genes are called ARTS1 and IL23R. These genes seem to play a role in influencing immune Function. It is anticipated that by understanding the effects of each of these known genes researchers will make significant progress in discovering a cure for Ankylosing spondylitis.
How does inflammation occur and persist in different organs and joints in Ankylosing spondylitis is a subject of active research. Each individual tends to have their own unique pattern of presentation and activity of the illness. The initial inflammation may be a result of an activation of body’s immune system by a bacterial infection or a combination of infectious microbes. Once activated, the body’s immune system becomes unable to turn itself off, even though the initial bacterial infection may have long subsided. Chronic tissue inflammation resulting from the continued activation of the body’s own immune system in the absence of active infection is the hallmark of an inflammatory autoimmune disease.
Treatment for Ankylosing Spondylitis
Ankylosing spondylitis treatment overview by Dr Singhal Homeo,
Ankylosing spondylitis affects young people, calling for planning of the long-term treatment in such a way that the disease remains under control, good relief in symptoms is achieved and dependency over chemical based medicines may be reduced, over the years.
The management of Ankylosing spondylitis included medicines, physiotherapy and exercise:
- Conventional medicine
- Homeopathic medicines
- Self-help Exercises
- Surgery (In extreme cases)
The purpose of treatment of Ankylosing spondylitis is:
- To get relief in pain
- To control the disease process
- To improve mobility
- To reduce stiffness
- To reduce dependency of chemical based medicine
A. Conventional medicines:
The most commonly used conventional medicines (also called as allopathic medicines) are:
a. Sulfasalazine (Salazopyrine):This immunosuppressive medicine has been used for various forms of arthritis including Ankylosing spondylitis, rheumatoid arthritis as well as for ulcerative colitis. It gives food results.
Downside: It gives drug-dependency. The adverse effects are agranulocytosis and reduction in sperm counts in young males.
b. Methotrexate: A powerful immunosuppressive medicine, gives quick relief but the disease returns on stopping the medicine, in most cases.
Downside: Produces drug dependency and many major adverse effects; so, not a common medicine of choice.
c. Corticosteroids: Similar to Methotrexate
B. Homeopathic medicines
Prescribed on the basis of individual case evaluation by taking into account patient’s genetic, immunological and psychological parameters. It is safe and effective as a long-term therapy. It reduces pain, improves mobility and most importantly, controls the disease. It has no adverse effects.
Downside: Homeopathic prescribing needs expertise. One may not find well-trained homeopaths in all parts of the world. The treatment is slow, relatively.
Strategic exercise done regularly with the help of a trained physiotherapist forms an important treatment for ankylosing spondylitis. Depending on the joints affected, different set of exercises could be prescribed to the patient.
Downside: Frequent sessions of physiotherapy may turn out to be expensive for some patients. The solution is to learn exercises from a physiotherapist and carry out at home, subsequently, without visiting the clinic or hospital.
D. Self-help Exercises
Every patient of ankylosing spondylitis must add exercise as a part of treatment. Regular exercise in terms of neck and other joint work out, walk, swimming, etc. help and are required for all the cases of Ankylosing spondylitis.
E. Diet in ankylosing spondylitis
There is no specific diet suggested to improve ankylosing spondylitis. However, it is advised to avoid sour food, which has been found to increase joint pain in many patients. Also, it is better to avoid animal proteins such as meat, which is hard on the immune system.
Surgery is not a commonly indicated treatment for ankylosing spondylitis. In advanced cases, when the deformity becomes very severe, leading to immobility on the joint, such as neck or hip, some re-constructive surgery may be required.
Overall, it must be remembered by all the patients of ankylosing spondylitis that if timely treatment is taken and supported with disciplined exercise and physiotherapy, the disease can remain under good control; and surgical intervention could be avoided.