Ankylosing Spondylitis - Overview

‘The young man woke up in the morning with a stiff back and feeling tired – indeed after moving about for some time, his back hurt less, just as his physician had said.’ This is the typical picture of an ankylosing spondylitis patient – whose spine is gradually getting ‘rigid’.

Ankylosing spondylitis affects as many as one to two out of every 1000 males globally; prevalence being much lesser in women. It is a rheumatic disease that causes chronic inflammation of joints (arthritis). The most commonly affected joints affected are those of the spine and the joints between the spine and the pelvis (sacro-iliac joints). The condition ultimately leads to rigidity (‘ankylosis’) of the affected joints on account of abnormal adhesion of the bones in the joint.

Homeopathy can provide good relief to the patients and control the progress of Ankylosing spondylitis. At Dr. Batra's, with our proficiency and experience of treating patients for the last 35 years, we can help patients to have good control over this condition and offer them effective and gentle pain control. Ultimately, we at Dr. Batra's strive to give the patients of ankylosing spondylitis a better quality of life, free from the pain of arthritis - one that can be lived to the fullest.

What is Ankylosing Spondylitis?

Fused with pain

Ankylosing spondylitis is derived from the Greek word ankylos meaning fused and spondylos which means vertebrae. Thus it’s a condition in which the ‘spine is fused’ - actually a presentation that is seen in advanced cases of this disease.

Ankylosing spondylitis is an inflammatory disease that affects multiple systems of the body though the commonest affection is of the joints. To make it more precise, the joints of the spine and those between the spine and the pelvis (sacro-iliac) are affected leading to chronic arthritis. Chronic inflammation in these areas causes pain and stiffness that worsens over a period of time.

As the disease progresses, the joints are immobilized on account of the abnormal adhesion (fusion) of the bones in the joints. When this happens to the spine, the condition is called as ‘bamboo spine’ since the spine becomes like one straight column that cannot be bent.

Other joints as well as organs of the body can be affected by this disorder and this includes the eyes, heart, lungs and kidneys.

Ankylosing spondylitis affects males almost two to three times more commonly as compared to females and can affect people of all age groups. However, it tends to present itself around the second to third decade of life.

Ankylosing spondylitis belongs to the group of conditions termed as ‘Seronegative Spondyloarthropathies’. This is because in this condition the Rheumatoid Factor (RF) is absent in the blood (seronegative) and the inflammation or arthritis involves the joints of the spine (spondyloarthropathy).

Causes

Can anyone explain what caused me to land up with this?

An interesting thing about ankylosing spondylitis is that the exact cause of this condition has not been clearly understood till date though it has been the subject of numerous studies!

Ankylosing spondylitis is considered to be a genetic disorder in which the HLA-B27 gene in particular has an important role to play. People with this particular gene have a significantly higher risk of developing ankylosing spondylitis. However, it must be noted that not every person who has the HLA-B27 gene develops this disorder. Thus there are some additional factors, probably environmental, that are involved in the development of this condition.

Patients with a family history of ankylosing spondylitis stand a greater chance to develop it as compared to those with no family history.

In addition, gender predilection has been strongly noticed in this condition. Males are almost 2 to 3 times more prone to develop this condition as compared to females.

The initial inflammation that activates the immune system is thought to be triggered by a bacterial or microbial infection. At a later stage, the immune system is unable to turn off this response which continues to attack the body’s own tissues now, in this case, the joints leading to arthritis. This explains the auto-immune nature of the disease.

Symptoms

“Slowly the pain in the back started, lasted a few days and then suddenly disappeared only to come back again after a few days”.

Gradual progress of ankylosing spondylitis makes it difficult for the patients to exactly pin-point the onset of the ailment. In addition, the initial symptoms are vague such as nagging pain and stiffness (arthritis) in the lower back and hips that has lasted for quite some time. Thus, by the time patients seek treatment, the disease has already progressed to a certain level.

The classical areas that are affected by this condition are:

  • Spine (cervical, dorsal, lumbar)
  • Sacro-iliac joints
  • Knees, hips, shoulders
  • Joints between the ribs and the spine
  • Eyes

Symptoms due to the affection of these areas include:

  • Backache and stiffness along the spine – usually worse in the mornings or after periods of inactivity
  • The joint pain (arthritis) experienced by the patient is often relieved by motion, applying local heat or taking a warm shower
  • Pain in the hips, buttock pain
  • Difficulty in bending down (inflexibility)
  • Stooping posture due to chronic back pain
  • Neck pain
  • Pain in heels
  • Affection of other joints leading to pain and stiffness – E.g. knee pain, shoulder pain, ankle pain
  • Expansion of the chest during breathing is restricted
  • Fatigue
  • Loss of appetite
  • Weight loss
  • Inflammation of the eyes (iritis) where there is redness of eyes and pain while looking at bright lights
  • Lungs may be affected by ankylosing spondylitis leading to breathing difficulty
  • Pain and stiffness in the back of the heel (Achilles tendinitis)
  • Inflammation of the tissues of the bottom of the foot causing pain (plantar fasciitis)
  • Rarely the electrical system of the heart may be affected leading to a slow heart rate – patient experiences symptoms of dizziness, fainting and shortness of breath in such cases
  • The kidney may also be affected leading to accumulation of the toxins in the body that causes nausea and chronic fatigue

Advanced cases with chronic affection can develop a completely fused spine – here all the joints in between the vertebrae are fused (ankylosed) and the patient develops an inflexible spine. The spine pain or backache usually disappears at this stage. Such a fused spine is very prone to develop fractures due to injury.

During the course of this disease, there are periods when the patient is absolutely free of pain or any complaints (remission) and periods when the disease becomes active again (relapses).

Diagnosis

The earlier Ankylosing Spondylitisis is diagnosed, better is the scope of treatment of the same. This is because ankylosing spondylitis tends to cause structural changes in the joints which may not be possible to reverse if the condition has advanced. The patient’s symptoms are the earliest pointers to this condition. Certain examination findings that help to confirm the diagnosis are:

  • A physical examination that clearly demonstrates inflammation (arthritis) and decreased range of motion of joints
  • Reduced flexibility of the lower back and neck along with a stooped posture
  • Tenderness of the sacroiliac joints (upper buttocks)
  • Limited expansion of the chest due to rigidity of the chest wall
  • Ophthalmoscopy: To evaluate inflammation of eyes

Investigations generally suggested to the patients: include

  • X-ray findings - indicative of the fusion of the joints
  • Computerized tomography (CT) scan or magnetic resonance imaging (MRI) to detect inflammation and other changes in the joints
  • Blood tests:
    • Erythrocyte Sedimentation Rate (ESR)
    • C-reactive protein (CRP)
    • Complete Blood Count (CBC) to determine anemia
  • Blood test genetic marker - HLA-B27 gene
  • Urine analysis to rule out kidney conditions that can cause back pain. This test also helps to keep a track on kidney functions in known cases of ankylosing spondylitis.
Complications

Are these signs I’m getting worse?

Ankylosing spondylitis runs a variable course in most patients with periods of remissions and relapses. The arthritis and other symptoms may gradually worsen over a period of time but most people remain functional unless severely disabled by the pain or immobilized due to fusion of the joints.

The complications of Ankylosing spondylitis vary from patient to patient and some of them are:

  • A stiff, inflexible spine: Also called as bamboo spine, this is caused due to fusion of the vertebrae of the spine rendering the joints immobile. This can cause significant discomfort while walking, standing, performing other day-to-day activities.
  • Restricted breathing: This can be a potentially dangerous situation in advanced cases where the bones of the rib cage fuse and restrict movement of the chest while breathing. This prevents the lungs from expanding fully during respiration.
  • Eye inflammation (Uveitis): This condition is marked by rapid onset of eye pain, increased sensitivity to light and blurred vision.
  • Heart problems: Stenosis (narrowing) of the aortic valve of the heart
  • Inflammatory bowel disease can occur in cases where the inflammation involves the bowels
  • Anemia: A condition in which the blood has less than normal number of red blood cells.
Homeopathic Treatment

Effective, soothing pain relief

At Dr. Batra's, we have the experience and the expertise of treating patients for the last 35 years and bring smiles to many suffering patients. It's our constant endeavor to impart a better lifestyle to our patients and help them live a pain-free life.

The beauty of Homeopathy is that this science has at least something to offer for most of the ailments. Likewise, even in Ankylosing Spondylitis, Homeopathy can offer significant pain relief to the patients. This holds especially true for cases that are in the early stages of the disease. At this stage, the medication can even help in slowing down the progress of the disease besides offering pain control.

As far as advanced cases are concerned where arthritis has advanced and immobilization of the joints has already occurred, there is nothing much that can be done for the patient except palliating the pain.

Timely treatment can prevent the onset of complications and can also prevent the disease from spreading to involve other organs of the body. In addition, the treatment can also help the patients to manage the feelings of depression, anxiety, withdrawal that many of them suffer from.

Regular exercises, swimming, breathing exercises, gentle stretches, etc. done under the supervision of a physiotherapist combined with Homeopathy can give good results in most cases.

Self Care

Ankylosing spondylitis patients usually face many periods of ups and downs during the course of the disease - there are days when the disease gets troublesome and times when they don’t even realize anything's wrong. However, making certain changes in their lifestyle can take them a long way and help them to deal more effectively with their arthritis and other symptoms. Based on our experience of treating many patients over the last 35 years at Dr. Batra's, we have found that the following can be helpful to patients of ankylosing spondylitis; these tips have a scientific backing and have also been repeatedly verified at the clinic level:

  • Maintain a healthy weight - lose that extra weight, if any, to avoid worsening of the joint pain
  • Eat a varied diet including plenty of calcium rich foods (sesame seeds, green leafy vegetables, ragi), whole grains, fruit and vegetables
  • Alcoholic beverages weaken bones. Consuming more than two alcoholic drinks per day increases a person's chances of developing weakened bones
  • Decrease your intake of saturated fats (dairy, red meat), salt and sugar
  • Swimming, underwater exercises (preferably in a warm pool) are good for people with ankylosing spondylitis
  • Deep breathing exercises help improve as well as maintain the lung capacity
  • Avoid sports or any activities that involve the risk of falling
  • Sleep on a mattress that is firm (not hard). Avoid using thick pillows since they cause the neck to bend forward
  • While working, sit in a chair that has an upright firm back
  • A hot bath or shower in the morning may help reduce pain and stiffness
  • Stop smoking