Understanding and managing ankylosing spondylitis

Ankylosing spondylitis is a type of arthritis that mainly affects the spine, causing inflammation of the vertebrae that can lead to chronic pain and disability. In severe cases, this inflammation can lead to the formation of new bone on the spine (ankylosis), causing sections of the spine to fuse in a discomforting position.

Additionally, the condition can cause inflammation, pain, and stiffness in other parts of the body like the shoulders, ribs, hips, heels, and joints in the hands and feet.

Causes
The exact cause of ankylosing spondylitis remains unknown, but researchers state that genetics play a key role in the development of the disease. More than 60 genes have been identified to be associated with ankylosing spondylitis and other related conditions.

As per hypothesis, ankylosing spondylitis may affect an individual when the defenses of their intestines collapse, allowing certain bacteria to pass into the bloodstream, triggering changes in the immune response.

Symptoms
The signs and symptoms of the condition differ from person to person. The distinctive feature of the disease is the involvement of sacroiliac joints—located at the base of the spine—during the progression of the disease. The most common symptoms of the disease are pain and stiffness in the lower back, along with pain in the hips and shoulders. Here are some of the other symptoms:

• Stiffness of the back that worsens during the night or in the morning
• Loss of appetite
• Mild fever
• Weight loss
• Fatigue
• Anemia or low iron
• Problems in lung function

In some cases, the condition also causes mild inflammation of the eyes (iritis or uveitis), leading to redness and pain. In some individuals, the heart valve is also affected.

Treatment
As of today, there is no known cure for ankylosing spondylitis, and treatment for the condition primarily aims to relieve the pain and stiffness. It may also significantly slow down or even stop some major complications like a bone deformity. Some common treatments are mentioned here:

• Medications
  There are several types of medications available for the treatment of ankylosing spondylitis, but the effectiveness of these medications is different in each person.
  Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen and naproxen are commonly used to manage pain and inflammation. When NSAIDs are not effective, the doctor may prescribe stronger medications.
• Surgery
  Depending on the severity of the damage, different types of surgeries are performed. Individuals with severe damage or deformity in the knee or hip joints require joint replacement surgery, while an osteotomy may be necessary for individuals with poor posture caused by fused bones.

Natural treatment
Other than medications, some natural treatments may help alleviate the symptoms of ankylosing spondylitis, and daily exercise and posture practice are primarily encouraged to maintain flexibility. These natural treatments can also be combined with medications, but it is important to consult a doctor before starting these treatments:

• Exercise and stretching
  Staying active is one of the best ways of managing ankylosing spondylitis. Range-of-motion exercises and strength training exercises help strengthen joints and make them more flexible. Stretching can also make the joints more flexible and improve their strength, alleviating pain.
• Posture training
  Over time, bones in the spine can fuse, causing the person to take up slouching positions. However, good postural habits can affect the pattern of fusion and prevent bone fusing in a position that is not upright. Also, individuals can always use supporting devices like chairs or seat cushions to improve their posture.
• Heat and cold therapy
  Using a heating pad for stiff joints and tight muscles can help reduce pain and soreness, and hot baths and showers can also provide great relief. On the other hand, ice packs can reduce swelling and muscle inflammation.
• Stress reduction
  People with ankylosing spondylitis have reported that stress and anxiety can aggravate the symptoms of the disease. To reduce stress, one can undertake meditation, counseling, breathing techniques, yoga, massage, and such.
• Diet and nutrition
  There is no particular diet routine to follow to manage the condition, but a healthy diet rich in vitamins and minerals is great to start with. It is highly recommended that the daily diet include the following:
• Foods rich in omega-3 fatty acids like nuts and healthy oils
• Different fruits and vegetables
• Whole-grain foods and whole grains like quinoa and farro

One must severely cut down or eliminate the foods rich in fat, sugar, and sodium, along with processed foods and boxed or canned foods. Apart from this, alcohol consumption should be avoided as it can interfere with the medications and worsen the symptoms.

Complications
If ankylosing spondylitis is left untreated, the following complications may arise.

• Fused vertebrae due to chronic inflammation
• Severe inflammation in nearby joints like hips and shoulders
• Breathing difficulties
• Heart, lungs, or bowel damage
• Eye irritation
• Compression fractures of the spine

It is important to remember that ankylosing spondylitis is a lifelong disease and its severity is independent of the age and gender of the individual. Even if one is experiencing only mild symptoms of the disease, it is wise for them to visit a rheumatologist for a checkup.

This article is for information purposes only. Always consult and seek the advice of a physician/licensed healthcare professional with any questions regarding a medical condition or medication.