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Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is an arthritis which affects the spine. It belongs to the category of ‘inflammatory arthritis’ where the immune system creates inflammation in joints and/or tendons. The term 'Spondylitis' means inflammation of the spine, and the word Ankylosis refers to a stiffening of the spine.

Who gets Ankylosing Spondylitis?

This condition can affect people of any age.

 

Typically it starts in young adult life, often in teenage years, only becoming apparent with age. Often earlier symptoms are not typical and can be confused with injuries at sport or the gym.

 

Later on as the disease becomes more established typical symptoms of pain and stiffness worse at rest and at night time become more obvious.

 

It can take many years before the disease causes any significant changes in the bones that can be seen on x-ray.

What are the symptoms of Ankylosing Spondylitis?

When the disease is early, symptoms can be quite unusual. Typical symptoms are pain in the buttocks alternating from side to side, and or stiffness in any area of the spine. It often starts at the junction of the thoracic and the lumbar spine.

 

Stiffness and pain in the early hours of the morning often waking from sleep and being relieved with stretching is quite common. Symptoms are often worse at rest, and relieved with stretching and activity. Symptoms that are worse at night and at rest are called 'inflammatory' in nature.

 

In time if the disease is untreated and/or progresses there can be restriction in the movement of the spine. Sometimes this can also affect the breathing as it limits the way the ribs can move as the lungs expand with air.

How is Ankylosing Spondylitis diagnosed?

Ankylosing Spondylitis is easy to diagnose if there are typical symptoms of inflammatory low back pain, changes of sacroiliac inflammation seen on X rays, and the presence of the gene HLA B 27 in the blood, and high inflammatory markers.

 

However, all of these things are not always present, particularly if someone is at the early stages of the disease.

Your doctor will order blood tests including HLA B 27, ESR CRP and will order x-rays of your spine and sacroiliac joints. Sometimes MRI's and Bone scans are ordered looking for the presence of more subtle inflammation which may not show up on x rays.

How is Ankylosing Spondylitis treated?

Early on the condition is treated with anti inflammatories, and exercise and stretching regimes. The disease can go through different periods of flares and then periods where it is not so active. Anti-inflammatories are usually taken when they are needed and not every day as there is a risk for significant side effects with long term anti-inflammatories.

If the condition becomes more marked and more significantly affects a person, drugs called Biologicals may be used.

 

People can only have these drugs subsidised by the government if they meet certain criteria of disease severity, which includes:

  • Evidence of grade 2 x-ray sacro-iliitis (inflammation of the sacro-iliac joints) and

  • Elevated markers of inflammation, (ESR and CRP) on blood testing.

  • Limited range of spinal flexibility

  • And, having failed to improve on anti-inflammatories

What is the long term outcome with Ankylosing Spondylitis?

The outcome of this condition is different for each person. No one can predict how the disease will be and what will happen for any individual. Each treatment program needs to be tailored for each person in conjunction with the treating rheumatologist.

In many people, the disease is quite mild, and in my experience if people require biological therapy it makes a huge difference to their day to day symptoms and long term outlook for many people, even if they may not 100% control all symptoms.

 

The outcome of Ankylosing Spondylitis is far different now than it was 20 years ago before we had good treatments such as biologicals.

Does diet make a difference in Ankylosing Spondylitis?

These days there is an unending supply of suggested wonder diets in the public domain and on the internet. It is increasingly complicated to know what to eat, nor is there evidence that the same diet works for all people.

 

Many of my patients with Ankylosing Spondylitis like to explore the impact of the way they are eating on their symptoms. After all, if anything can reduce the amount of long term anti inflammatories and thus reduce risk of long term side effects from these drugs, that is a good thing.

 

There is no one diet for Ankylosing Spondylitis but there are some suggestions of things that may make a difference. There are no large double blinded randomised controlled trials, but that does not mean that something may not make a difference for you. Given the low risk of diet, if its something of interest to you, my suggestion is to explore various things, and see if they make a difference for you. That is the best proof for you, whether your symptoms are improved, or not.

 

Many of my patients give me feedback that a low starch diet makes a difference for them. Some people find that natural anti-inflammatory supplements such as curcurmin or turmeric are of assistance. Some people find that gluten free helps them and there is some limited evidence that a gluten free diet reduces sacroiliac inflammation. However there is no one diet for AS and the important thing is to explore what makes a difference for you

 

If you're considering making changes in your diet to see if you can improve your symptoms, its my recommendation that you get the support of someone with a nutritional qualification to make sure you get appropriate minerals and vitamins and nutrition in your diet for your health and well-being.

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