What is ankylosing spondylitis?
How do I know if I may have ankylosing spondylitis?
- In the early course of the disease, the pain can be intermittent and comes and goes. The pain can often be intense enough to awaken someone from sleep. Physical activity and exercise can often help alleviate the pain.
- As this condition progresses, it can involve all or part of the spine. You may notice severely limited movement in the lower spine.
- If ankylosing spondylitis affects the mid-back (or the thoracic spine), you may not be able to fully expand your chest because the joints between the ribs are involved.
Are there any other health conditions associated with ankylosing spondylitis?
In addition to the spine, other organs of the body that can be affected by ankylosing spondylitis include the eyes, aorta, and the lungs. Remember that because this is an inflammatory condition, body areas other than just the spine can be involved.
How is this condition diagnosed?
- There are some physical examination tests that your healthcare provider can do that can strongly suggest this condition is present. One of them is called the Schober’s test which is a measure of how well you can bend forward. Remember that with ankylosing spondylitis, movement, especially bending forwards can be extremely limited.
- Imaging studies can be strongly suggestive of this condition. Your healthcare provider may discuss with you obtaining an X-ray of your lower back and pelvis. A MRI can also be done as a more specialized confirmatory imaging test.
- There is a special kind of blood test called HLA-B27; this test is often positive in someone with ankylosing spondylitis.
- This condition can often be dismissed by healthcare providers in the early stages because the symptoms are often intermittent. You know your own body better than anyone else. It is important to find a practitioner who will listen to you.
What are some common medications used in the treatment of ankylosing spondylitis?
- If you are on this medication, your healthcare provider will need to monitor your blood count, liver function and kidney function through routine blood work as these processes can be affected by this medication.
- Because this medication can disrupt folate metabolism, folic acid usually needs to be supplemented.
- This medication can increase your risk of getting cancer; in addition, it can also increase the risk of developing autoantibodies and the risk of acquiring other immune related syndromes.
- If you are ill or have an infection, this medication should be held because it can interfere with your body’s ability to fight off the infection.
- This medication and other medications that suppress your immune system increase the risk of developing infections.
- One of the main differences in this diet is that you are looking to eliminate foods that may potentially be causes of food sensitivities or foods that have the ability to stimulate inflammatory responses. One of the most common examples of this is gluten in celiac disease. On an anti-inflammatory diet, all possible sources of food sensitivities are eliminated and then reintroduced one at a time.
- Another way is to have your blood tested for food sensitivities.
- Be aware that different foods, even among fruits and vegetables, can have different degrees of inflammation. There is a great site at www.nutritiondata.com that has an Inflammatory index that can tell you about the inflammatory power of the foods that you are eating. You want to focus on foods that have a high anti-inflammatory index.
Other Nutritional Recommendations:
- Stay away from sugar: sugar can be a potent source of inflammation. Eliminate this from your diet, and you can see a change in how you feel as well. Remember that Candida can also promote Candida overgrowth in the intestine which can also promote inflammation as well via the production of mycotoxins.
- Juicing in the morning is a great way to start the morning and get a great anti-oxidant kick to start your day.
- A good anti-inflammatory dose begins at least 3-4 grams a day to start and slowly increased to a maximum of 7-8 grams.
- As this supplement can thin the blood, if you are on any blood thinners, you may wish to start at a lower dose and increase the dose slowly.
- If you have allergies to pineapples or papaya do not take this supplement.
- It is best taken on an empty stomach; be aware that you may need to take 6-12 tablets a day for an inflammatory response.
- In one study, Turmeric was as effective as an analgesic in controlling post-operative pain.
- It comes in tablet or liquid form. Many prefer the liquid form and good maintenance dose is 1 ounce twice a day of the liquid formulation.
- Noni can come in capsule or juice form. If you take the juice form, begin at 1 ounce twice a day and increase slowly to 4-6 oz a day.
- Some forms of Noni can have a high potassium content, so if you have kidney disease you need to be mindful of this.
- Extremely high doses of this may have an adverse effect on the liver, although this is controversial. The several ounces a day that we mention here is very low dosage of this supplement.
Developing an Exercise Regimen
- Yoga: Yoga is a great way to increase back flexibility as well as decrease pain in ankylosing spondylitis. It is important to start slowly and work with a certified instructor to learn the right way to do each exercise. Yoga is especially effective if started in the early stages of this condition.
- In addition to the exercise regimen mentioned above, if you have ankylosing spondylitis you should also consider seeing someone who is holistically trained in trying to help you regain more function and flexibility in your lower back. This can include seeing a structural integration specialist, chiropractor, and/or a specialist in osteopathic manipulation.
Agarwal KA, Tripathi CD et al. “Efficacy of turmeric (curcumin) in pain and postoperative fatigue after laparoscopic cholecystectomy: a double-blind, randomized placebo-controlled study.” Surgical Endoscopy. 2011 Dec;25(12):3805-10.
Basar S, Uhlenhut K et al. “Analgesic and antiinflammatory activity of Morinda citrifolia L. (Noni) fruit.” Phytotherapy Research. Jan;24(1):38-42Edavalath M. “Ankylosing Spondylitis.” Journal of Ayurveda and Integrative Medicine. 2010 Jul;1(3):211-4.
Hemarajata P, Versalovic J. “Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation.” Therapeutic Advances in Gastroenterology. 2013 Jan;6(1):39-51.
Kuehl KS. “Cherry juice targets antioxidant potential and pain relief.” Medicine and Sports Science..Medicine and Sports Science. 2012;59:86-93.
Smith JP, Bingaman SI et al. “Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn's disease: a randomized placebo-controlled trial.” 2011 Jul;56(7):2088-97.
Sundstrom B, StalnackeK et al. “Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis.” Scandinavian Journal of Rheumatology. 2006 Sep-Oct;35(5):359-62.
Younger J, Noor N et al. “Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels.” Arthritis and Rheumatism. 2013 Feb;65(2):529-38
Youssef AA, Al-Deeb AE. “A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component.” Anesthesia. 2013 Mar;68(3):260-6.
Written by Rich Snyder, DO
Updated: May 2013