Written by Dr. Rich Snyder
Ankylosing spondylitis is an inflammatory disease that affects the joints (called the sacroiliac joints) in the lower back in between the spine and pelvis.
It is an inflammatory arthritis that particularly affects younger people, predominantly males, between the ages of 20 and 40.
What is ankylosing spondylitis?
Ankylosing spondylitis is an inflammatory disease that affects the joints (called the sacroiliac joints) in the lower back in between the spine and pelvis. These joints over time often become swollen and inflamed. One potential complication of this condition is that the spinal bones can fuse together.
How do I know if I may have ankylosing spondylitis?
This is a form of inflammatory arthritis that particularly affects younger people, predominantly males, between the ages of 20 and 40. Common symptoms include worsening lower back pain in the absence of trauma; others include stiffness, and decreased ability to bend forwards.
- 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?
In a young person, low back pain is often a self-limiting condition that gets better with conservative measures. In someone whose back pain still persists with some of the symptoms described above, it can and should be a red flag that further evaluation is needed.
- 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. An 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?
Many of the medications commonly prescribed in the treatment of ankylosing spondylitis work by suppressing the immune system. They are often prescribed by a rheumatologist, who is a medical specialist trained in the evaluation and management of inflammatory conditions. Examples include:
Methotrexate: This medication is often given once a week and the dose is increased slowly.
- 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.
There is a class of agents called biologic agents. One example is adalimumab (Humira). This medication inhibits a potent pro-inflammatory protein called Tumor Necrosis Factor (TNF). This is an injection that strongly suppresses the immune system.
- 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.
Your intestine is the one of the main keys to fighting and reducing total body inflammation. Forming a solid nutritional plan is vital: one of the best nutritional plans for fighting inflammation is the anti-inflammatory diet.
Foods can be a source of inflammation, especially for people with food sensitivities. Because the etiology of ankylosing spondylitis is not known, you want your nutrition plan to be as inflammatory free as possible. This is a diet similar to other diets, including the DASH diet and Mediterranean diet in that it has a focus on fruits and vegetables which in general are non-inflammatory.
- One of the main differences in this diet is that you are looking to eliminate foods that may potentially be the cause 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.
Many of the supplements below help normalize immune function and bowel flora as well as reduce inflammation and pain.
Probiotics: These should be a mainstay in any inflammatory condition. They can normalize the bowel flora and replace the bad bacteria with good intestinal microflora. Studies specific to their benefits in ankylosing spondylitis have been mixed, but they do have an effect on immune system modulation and are often included in any anti-inflammatory regimen.
Omega 3 fish oil
A Western diet is high in Omega 6 and is pro-inflammatory. Changing your diet to reduce Omega 6 (which can be done with an anti-inflammatory diet) and supplementing with Omega 3 fish can help reduce inflammation and pain. In one study from 2006, the use of Omega 3 fish oil markedly showed a decrease in disease activity in patients with ankylosing spondylitis.
- 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.
This is an enzyme supplement that is used in the treatment of inflammation and pain. Enzymes in this supplement include bromelain (from pineapple) and papain (from papaya).
- 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.
It is a great anti-oxidant that can reduce inflammation and pain. It can be taken as a 400 mg capsule daily or as a powder that can be sprinkled on each meal.
- In one study, Turmeric was as effective as an analgesic in controlling post-operative pain.
Tart cherry extract
Specifically Montmorency tart cherry extract is excellent for decreasing pain and inflammation.
- 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.
There are some good, natural pain formulations that contain many potent herbs that are great for reducing pain and inflammation in one capsule. Examples include curcumin (the main ingredient in Turmeric), Boswellia extract and Devils claw. Examples of these formulations include Arthrocin and Zyflamend.
Magnesium deficiency can promote inflammation and pain. For sore muscle and/or joints, the use of Magnesium gel or oil applied directly to the area can promote healing and reduce inflammation and increase joint and muscle mobility and flexibility.
Morinda citrifolia (Noni)
This is a tropical plant from East Asia that has been used for many years. It has anti-inflammatory properties and can help in the treatment of pain.
- 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.
While physical activity and exercise can help in the treatment of ankylosing spondylitis, it does not mean that you will be able to tolerate any and all exercise regimens. Activities such as swimming and aqua-therapy, where there is not as much direct pressure placed on the back are preferred over running or jogging.
- 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.
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Updated: May 2013