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Ankylosing spondylitis

Definition:

Ankylosing spondylitis is a disease of the joints specially of the spine, found commonly in early twenties or later. It is a type of chronic degenerative arthritis, where there is long standing inflammation of the spinal vertebrae, predominantly the joints between the spine and pelvis (sacro iliac joints), affecting more of the neck and/or lower back.

 

Ankylosing spondylitis is also called as Marie-Strumpell arthritis, Bechterew’s disease or Pierre- Marie’s disease.  The name is derived from the Greek word where, “ankylos” means fusion or stiffening , “spondylos” means vertebra and “itis” means inflammation. As the name suggests, it leads to progressive fusion of the joints of the spine leading to painful stiffness of the back.

 

The patient is often seen walking with a stoop posture due to a rigid spine in the later stages. Hence it is also called as “bamboo” spine, as in the X ray film the spine looks stiff like a bamboo. 

 

Ankylosing spondylitis majorly affects the spine, but it can also involve the ribs, eyes, heart, lungs etc. 

Incidence:

It affects about 0.1% to 0.5% of the adult population. Males are more commonly affected than females. Ankylosing spondylitis can occur at any age but is often triggered in the men who are in their teens and adults between 20 to 40 years of age. When it affects the children the condition is called a juvenile ankylosing spondylitis.

Causes:

The causes include a combination of genetic and environmental factors.

  1. Genetics: It is found that about 90% of individuals suffering from ankylosing spondylitis are born with the HLA B27 gene (Human Leukocyte Antigen). However, HLA B27 is not the absolute diagnostic criterion for the disorder. Many individuals suffering from similar symptoms might have the HLA B27 test negative, where the condition is known as seronegative ankylosing spondylitis.  At the same time, all the patients who are positive for HLA B27 may not have actual Ankylosing Spondylitis.

  2. Autoimmunity: The underlying mechanism which triggers this disorder is autoimmune, which is again genetically inherited.

  3. Long standing stress: Stress can be a major triggering factor for ankylosing spondylitis. Individuals under prolonged stress situations give a sufficient reason to provoke this disorder at some stage in their life.

Symptoms of Ankylosing Spondylitis:

Early symptoms:

  1. Pain and stiffness: Constant gradually increasing annoying pain and stiffness in the lower back, hips (sacroiliac joints) and sides of the lower back (loins). The pain may get aggravated after sitting for a long time or on sitting after standing for a long time. Patients often complain of morning stiffness which may awaken them early morning. The pain may generally improve with physical activity, while walking, having a warm bath and massage.

  2. Limitation in normal movements: The bony fusion of the spine and vertebrae leads to impairment in the normal movements of the spine. It limits the person’s ability to perform daily routine activities. Fusion of the ribs to the spine causes difficulty in taking a deep breath.   

  3. Easy tiredness: This is the most common symptom that the patient usually complains about, which may be overlooked in the early stages. It may be mistaken for deficiencies like calcium and vitamin D and the diagnosis therefore can get delayed. The patient may say that “I get tired easily after walking longer distances which I could easily walk earlier”. He or she may complain of fatigue after walking for a short interval.

  4. Loss of appetite and weight loss: Ankylosing spondylitis is a systemic disease where symptoms may not be only limited to the joints. Patients may gradually lose their weight and complain of loss of normal appetite.
  5. Localized pain: There may be localized pain in knees, heel, ankles and feet where the tendons meet, as a result of inflammation and swelling.

  6. Eye pain: Few groups of individuals suffering from ankylosing spondylitis complain of eye pain, redness and sensitivity to light due to inflammation of the anterior chamber of the eye (iritis or uveitis).       

Late symptoms

  1. Stoop posture: The individuals at later stage attain a stooped posture due to permanent fusion of the spinal vertebrae.

  2. Pain and stiffness: The intensity of pain and stiffness increases now and may not respond to previously administered pain relieving medicines.

  3. Quality of life: The individuals may not be able to perform their daily routine activities as efficiently as before, that hampers the quality of life.

Diagnosis

Ankylosing spondylitis can be diagnosed through a detailed case taking, physical examination, nature of pain, a positive HLA B27 biomarker, positive family history for ankylosing spondylitis. The diagnosis can be confirmed through radiographic imaging (X- ray whole spine) or MRI of the spine which shows fusion and inflammation of the spine and sacroiliac joints.  Other blood investigations which would guide the diagnosis include ESR (erythrocyte sedimentation rate) and C reactive protein levels which are elevated. Finally, a clinical examination and evaluation by an expert is the best wasy to confirm or rule out the diagnosis of Ankylosing Spondylitis

 

Treatment for Ankylosing Spondylitis

1. Conventional treatment: The conventional line of treatment typically involves pain relieving medications and immunosuppressants.  NSAIDs (non-steroidal anti- inflammatory drugs) like naproxen, ibuprofen, indomethacin and diclofenac are commonly used to relieve pain. But the condition is not controlled with NSAIDs alone. They have to be complemented with anti- rheumatic drugs like sulfasalazine and methotrexate which suppress the immunity and give long term reduction in the inflammatory process.  Corticosteroids are other immunosuppressive group of medicines that help significantly in reducing the inflammation in the joints. All these medicines have to be taken regularly for a long time for a sustained recovery, since the condition relapses after tapering or stopping of the medicines (withdrawal effect). However, they give potential side effects and have to be substituted after a certain period of time. At the end stage, when patients fail to respond to immunosuppressant’s and NSAIDs as effectively as before, medical research has come up with a group of medicines known as biologics (Remicade) which give sustained pain relief for years together.  For those individuals with eye pathology, Atropine eye drops are usually suggested to reduce the inflammation.  All these drugs are potentially toxic to the liver and bone marrow, hence a group of blood tests have to be carried out at regular intervals to monitor any organ damage.

 

2. Homeopathic treatment for Ankylosing Spondylitis

Ankylosing spondylitis is a challenging disease to treat. Homeopathic treatment is highly effective in controlling the disease especially in the early stages. In later stages, homeopathy is better complemented with conventional line of treatment works efficiently in controlling the disease pathology. Both the treatments can be safely taken in parallel without one intruding into another.

Homeopathic treatment aims at improving the immunity at such a level where the body is able to fight back the disease more effectively. The exact time of treatment cannot be predicted, though it can be said that the earlier the treatment started the lesser is the time required for the treatment. A number of factors like a positive family history, age of patient and other accompanying systemic illness also guide us in deciding the duration of treatment.  However, a long term treatment is usually suggested for such chronic and difficult diseases. There is an individualistic approach towards each patient with ankylosing spondylitis.

 

A detailed case history and thorough clinical examination with apt investigation confirms the diagnosis, the constitution, life space and depth of the disease is graded in order to select a medicine suitable for the patient. There are few homeopathic medicines which work at the musculoskeletal level and prove effective in reducing the inflammation in bones and muscles thereby controlling the pain, stiffness. They can be safely administered for a long time as they do not have any side effects.

 

Complementing this combination of treatment with specific exercises also helps in preventing immobilization of the joints thereby  reducing the stiffness. Maintain an erect posture while sitting and take breaks frequently when at work. So opt for homeopathy at the earliest to minimize the dependency on pain killers and immunosuppressive medicines and gain maximum benefits of this natural treatment.      

 

 

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*Please note that results and duration of treatment may vary depending on the constitution of your body.