What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a chronic inflammatory and degenerative disease of the joints. Any inflammation of the joints is called ‘arthritis’. Ankylosing Spondylitis affects the joints between the vertebrae of the spine and the joints between the spine and the pelvis (sacroiliac joints). This condition may also affect other body joints adversely. 

The joints in the body get inflamed initially, and the inflammation may be followed by progressive inflexibility and stiffness.

As ankylosing spondylitis is a progressive disease, it eventually leads to the fusion of the spine resulting in permanent painful stiffness and inflexibility of the back. It is often called a bamboo spine, as the spine tends to get stiff like bamboo. If ribs are affected due to ankylosing spondylitis, it can limit the movement of the rib cage leading to difficulty in breathing. It can also affect other organs, such as the eyes, heart, lungs, or sometimes kidneys.

The occurrence of ankylosing spondylitis is observed to be often genetically inherited. Most people who have ankylosing spondylitis have the HLA-B27 gene in their blood. But, many individuals who have this gene in their blood never develop ankylosing spondylitis.

Early diagnosis and proper management of the disease can slow down the progress of the disease can prevent further complications.

Homeopathic Treatment for Ankylosing Spondylitis:

• Ankylosing spondylitis is a chronic progressive autoimmune disease that requires aggressive and strategic, long-term treatment.
• As per our experience where we have treated hundreds of cases of Ankylosing Spondylitis at Life Force, homeopathy helps this disease by:
• Controlling the disease process
• Reducing the pain and stiffness
• Improving mobility to a certain extent
• Reducing the dependency on chemical-based medicines
• As it is a deep-seated autoimmune disease, it needs to be treated with internal deep-acting medicines.
• A single line of treatment is not sufficient to take care of the disease over a long period. The only use of conventional treatment is not enough. If it is augmented with homeopathy treatment at the proper time, it helps tremendously.
• Homeopathic medicines are prescribed based on individual case evaluation, by taking into account the patient’s current status of the disease, the cause of the disease, and genetic, immunological, and psychological parameters.

The Objectives of Homeopathic Treatment for Ankylosing Spondylitis:

• To reduce pain, swelling, and stiffness.
• To improve the flexibility and recovery of physical functions related to daily routine and work activities.
• To slow down the disease progress and structural damage.
• To improve the quality of life of the patient.

How Homeopathic Treatment Can Help in Managing Ankylosing Spondylitis?

• Homeopathic treatment treats the disease internally and tries to correct the altered immune system.
• It reduces pain, stiffness, and swelling and helps improve the mobility of the affected joints.
• Timely administered homeopathic treatment can slow down the progression of the disease and further complications.
•  It can reduce the dependency on conventional medicines (like painkillers)
• It is safe, non-toxic, and effective as a long-term therapy.

Duration of Homeopathic Treatment:

As ankylosing spondylitis is a chronic, progressive, and difficult disease to treat, the exact duration of treatment cannot be decided. Most patients achieve better pain control in about 4-6 weeks. The treatment is long-term and it needs to be followed continuously for over two years.

The total length of treatment varies from patient to patient, depending on the following factors:

• Duration of the disease
• The extent of damage to the joint. The extent of fusion of the joints
• The extent of the spread of the disease to other joints or organs
• Genetic tendency
• Patient's age and general vitality
• Previous medication (Extensive use of oral cortisone)

Commonly Prescribed Homeopathic Medicines In Ankylosing Spondylitis

Commonly Prescribed Homeopathic Medicines In Ankylosing Spondylitis are Rhus Toxicodendron, Cimicifuga, Kali carbonicum, Sepia, Natrum muriaticum, Thuja occidentalis, Sulphur, Kalmia latifolia, and some more. There are about 50 possible medicines to select to treat the condition, based on the individual case analysis. These medicines must be taken under supervision and by prescription.

1) Rhus-Toxicodendron:
The permanent cure for ankylosing spondylitis in homeopathy, it is a homeopathic remedy often used for various types of musculoskeletal issues, including those associated with Ankylosing spondylitis (AS). It is indicated for stiffness in joints and spine which gets worse with inactivity such as sitting for a long time or after waking up in the morning.  The symptoms improve with movement and warmth. The complaints are associated with restlessness and a strong desire to constantly move to find relief from pain and stiffness, this restlessness is a key feature as they need to change positions frequently to alleviate the pain.
 

2) Cimicifuga (Actaea racemosa):
Cimicifuga homeopathic medicine for ankylosing spondylitis is often used for Ankylosing spondylitis when the patient experiences severe muscular pain and stiffness, particularly in the neck and upper back, with pain that can radiate to the shoulders and arms. The pain is severe, aching, cramping muscular pain, sometimes described as being deep and sore, especially in the neck, shoulders, and upper back. The stiffness is in the neck and back. They do experience mood swings and tend despondency.
 

3) Kali-carbonicum: 
In cases of Ankylosing spondylitis with significant pain in the lumbar and sacral lower back regions, Kali Carbonicum ankylosing spondylitis homeopathic medicine is indicated. The pain is described as sharp, and stitching back pain and feels deep and can be debilitating, that worsens in the early morning and with cold drafts. The pain is worse in the early morning typically around 2-4 am making one wake up from sleep because of severe pain. There is marked stiffness that gradually improves as the day progresses. There is a desire to support the back such as pressing against a firm surface or using a support belt that provides temporary relief from the pain and discomfort. Along with these physical symptoms, Kali carb patients often experience anxiety and irritability and tend to startle easily.
 

4) Sepia: 
It is indicated for Ankylosing spondylitis when a patient experiences persistent aching lower back pain. There is the sensation of dragging, and heaviness in the lumbar region which worsens with prolonged sitting and standing and improves with vigorous exercise and physical activity.  The patients do feel better after involving in activities that increase blood flow and movement. Like Rhus-tox changing the position often helps to relieve the discomfort. The patients needing Sepia experience emotional symptoms such as indifference and depression with the desire to be left alone.
 

5) Natrum muriaticum: In homeopathy for ankylosing spondylitis for those with chronic back pain that feels as though it is bruised and worsens with exertion, Natrum Muriaticum is often indicated.  This remedy is particularly useful for patients whose pain intensifies with emotional stress or grief.  Alongside the back pain, patients also report a general feeling of weakness and fatigue, which can hinder their ability to perform everyday tasks.

6) Thuja occidentalis: 
In ankylosing spondylitis homeopathic treatment, Thuja is for stiffness and pain in the spine and joints which are worse in the morning or after rest. There is the sensation of brittleness in affected areas, they do feel as if their spine or joints are easily breakable. The affected areas feel swollen and painful to touch. There can be a history of warts or other skin conditions along with Ankylosing spondylitis symptoms. The light gentle movements provide temporary relief. It is indicated when there is history of immunization, patients who have adverse reactions to vaccinations.
 

Pathogenesis of Ankylosing Spondylitis:

Multiple factors, such as the immune system of the body, the HLA-B27 gene, family history, stress, and other environmental factors, are responsible for the development of ankylosing spondylitis.  A typical histological finding in ankylosing spondylitis is called Enthesitis. Enthesis is the insertion of a tendon, ligament, capsule, or fascia into the bone. In ankylosing spondylitis, this enthesis is inflamed at the vertebrae of the spine. Studies show that the entheseal  fibrocartilage is the major target of the immune system and inflammation in ankylosing spondylitis. In addition to this, there occurs the inflammation of the synovium that forms a cushion in the joints. As ankylosing spondylitis is a progressive disease, tissues around the joints and cartilage get destroyed gradually as the disease progresses. Further, a bony growth replaces the original and new cartilages by fusing them. This leads to the fusion of the joint bones which in turn causes the stiffness and immobility of the affected joints. This is predominantly observed in the affection of the spine in ankylosing spondylitis.

Prevalence:

Ankylosing spondylitis is more common in males as compared to females. The most commonly affected age group is between 16-40 years. Usually, the onset of the disease is between the second and third decades of life.

Causes of Ankylosing Spondylitis:

Ankylosing spondylitis is known to be an autoimmune ailment. The exact cause of the disease is not completely understood. Some factors are responsible for the development of ankylosing spondylitis.

1. Genetic factor:

Ankylosing spondylitis has a strong genetic factor as a cause for its development. About 90% of individuals suffering from ankylosing spondylitis are born with the HLA B27 gene. The presence of the gene HLA B27 can be detected by blood tests. Some additional environmental factors are responsible for the disease to occur or get expressed. However, the presence of HLA-B27 (i.e. Human Leukocyte Antigen B27) is not diagnostic of this disease i.e. Ankylosing spondylitis.

Individuals with HLA B27 having a family history of ankylosing spondylitis are at risk of developing the disease.

2. Risk Factors:

• Age: It tends to start between the second or third decade of life.
• Sex: Males are more prone to develop the disease than females
• Stress: A prolonged stressful situation in one's life could trigger the underlying genetic tendency for AS.

3. Autoimmunity: Autoimmunity is considered to play a significant role in the development of ankylosing spondylitis.

The exact mechanism is not known, but the initial inflammation may be a result of activation of the body's immune system by a bacterial infection, a combination of infectious microbes, or other environmental factors. Chronic tissue inflammation resulting from the continued activation of the body's own immune system leads to the progress of the disease.

Symptoms Of Ankylosing Spondylitis:

Initially, the patient may present with pain and stiffness in the lower back and hips, particularly in the morning and after periods of inactivity. A few patients may present with neck pain and fatigue.

Symptoms may develop slowly over some time and may fluctuate. In some patients, the onset of symptoms is very rapid and intense.

1. Pain & stiffness in back and sacroiliac joint:

One may experience pain and stiffness in the lower back, hips, neck, or whole spine. Pain and stiffness affect more in the morning, at night, or after a prolonged period of inactivity.

The intensity of the pain and stiffness may increase as the disease progresses. Many patients need painkillers multiple times in a day to get some relief. Pain and stiffness are often relieved by motion, heat, and warm applications.

2. A fusion of bones:

As the disease progresses, patients with ankylosing spondylitis may develop a complete bony fusion of the spine. Once fused, it can affect the mobility of the spine. In turn, it affects the patient’s ability to perform everyday tasks.

The fusion of the ribs to the spine and forward curvature of the thoracic spine may limit the patient’s ability to expand the chest when taking a deep breath.

These fused spines tend to be brittle and are vulnerable to breakage (fracture) when affected by trauma, such as motor vehicle accidents.

3. Inflammation of lungs:

Ankylosing spondylitis may cause inflammation of the lungs causing coughing and shortness of breath, particularly after exercise and infections. So, breathing difficulty due to the inflammation of the lungs can be a serious complication due to ankylosing spondylitis.

4. Involvement of other joints: Arthritis

Ankylosing spondylitis can cause arthritis in joints other than the spine. The patients may present with pain, stiffness, swelling, warmth, or redness of joints, such as the hips, knees, ankles, small joints of hands or feet, and other body joints. Inflammation of cartilage of ribs called costochondritis can be seen in some patients.

5. Inflammation of tendons and ligaments:

Ankylosing spondylitis can cause tendinitis (inflammation of tendons) or enthesitis (inflammation of ligaments). The tendon is where the muscles attach to the bone, and the ligament is the connective tissue that connects bone to bone.

Some people suffering from this disease tend to develop Achilles tendinitis causing pain and stiffness in the back of the heel while walking.

A few patients may develop plantar fasciitis i.e. inflammation of the fascia of the bottom of the foot.

Complications due to Ankylosing Spondylitis

1. The affection of eyes: Iritis and Uveitis

Patients with ankylosing spondylitis can develop inflammation of the iris called iritis causing redness and pain in the eye and difficulty while looking at bright lights. Recurrent attacks of iritis can affect either eye.

The disease may affect inflammation of the ciliary body and choroid of the eye known as uveitis.

2. The affection of the kidney:

As ankylosing spondylitis progresses, it can lead to deposits of protein material called amyloid into the kidneys and result in renal failure. The progressive renal disease can lead to chronic fatigue and nausea and may require dialysis.

Diagnosis Of Ankylosing Spondylitis

Early diagnosis plays a crucial role in the management of ankylosing spondylitis. Early diagnosis and proper management of the disease can slow down the progress of the disease and can prevent further complications.

Diagnosis of ankylosing spondylitis can be made with the help of clinical evaluation, blood investigations, and radiological findings.

1)    Clinical Evaluation:

Clinical evaluation is done by the treating doctor with careful history-taking which includes family history, disease history, past medical history, and thorough physical examination.

In history-taking, the patient may point out the presence of chronic back pain with stiffness at least for 3 months, inflammation of the eyes (uveitis or iritis), a history of gastrointestinal infection, and a family history of ankylosing spondylitis, and other similar factors.

Physical examination reveals the presence of swelling, tenderness, and the limitation of the range of motion of the affected joints. Physical examination may also reveal decreased chest expansion.

2)    Blood Investigations:

Presence of HLA B27 genetic marker:

The HLA-B27 antigen is positive 90%-95% of the time, but please note that it is not always present. Its presence in the blood is not sufficient to make the diagnosis. The test is quite helpful when the diagnosis of the condition is not clear.

Routine blood tests, such as CBC and ESR, may suggest the presence of active or chronic inflammation in the body.

Erythrocyte sedimentation rate (ESR) is normal or can be mildly elevated. ESR is more likely to be elevated with active inflammation.

• Low hemoglobin levels may indicate anemia due to chronic disease.
• With the increased disease activity, C-reactive protein may be elevated.
• Serum alkaline phosphatase may be elevated in active bone affection.
• Go for the RA test and ANA test to rule out Rheumatoid Arthritis and lupus.

3)    Imaging Studies:

X-Ray:

• X-ray of the sacroiliac joint:  It may show inflammation of the sacroiliac joint (sacroiliitis) and the fusion of the joint.
• Lumbar spine X-ray: A radiographic study of the lumbar spine shows the ossification of the anterior longitudinal ligament.  It may help in diagnosing a condition known as the bamboo spine where there occurs a fusion of facet joints of the spine leads to the development of the bamboo spine.
• In progressive and extensive cases of ankylosing spondylitis, a patient may have a poker spine that can be detected on an X-ray study.

CT Scan:

• CT scan may help to find out the extent of bony fusions and erosion of the laminae and spinous processes which in turn helps to know the damage caused by the disease.
• CT scan of the spine is quite helpful in evaluating bone injury after trauma.

MRI

• MRI may help in diagnosing conditions like atlantoaxial subluxation.
• MRI is indicated after trauma where it helps to evaluate the spinal cord injury if any. It also helps to rule out other disease conditions, such as cauda equina syndrome or epidural hematoma.
• The cause of Cauda equina syndrome may be inflammatory or compressive. In the case of inflammatory cauda equina syndrome, which is best seen on MRI, the spinal canal appears normal to large with CSF diverticula.

Supportive Treatment (Diet, Lifestyle, & Exercise) for Ankylosing Spondylitis:

If certain auxiliary measures are followed along with proper treatment when treating ankylosing spondylitis, it helps in reducing the discomfort and may help to slow down the progress of the disease. Here are few a self-care tips to follow:

1. Maintain a correct posture and take care of your spine: Maintaining a correct posture while you sit or stand may help you manage ankylosing spondylitis.

   • Avoid slouching in the chair. Sit and stand straight.
   • Make sure that your chair at home and work has a firm seat and firm back which offers good support to your back and head.   
   • Avoid sitting on low and soft chairs, as it may encourage improper or bad postures and aggravate your discomforting pain.
   • Move your spine regularly.
   • Sit tall and slightly push your shoulders backward, it will stretch and straighten your spine.
   • If you have to sit for long in one place, get up and walk around in between.
   • Use a thin pillow, which gives your neck good support and suits your position while sleeping.
   • Use a firm bed and make sure it does not sag.
   • Lie flat either on your back or stomach every day for about 20-30 minutes.

2. Do exercises regularly: Regular exercises help maintain flexibility and reduce stiffness and pain.

   • Do planned exercises every day as suggested by a trained physiotherapist.
   • Do some stretching exercises daily: Stretching helps build flexibility and may reduce the pain.
   • Daily breathing exercises are effective in keeping the joints between your ribs and spine flexible. 
   • Some forms of yoga, regular walking, and swimming may help many patients with ankylosing spondylitis. 

3. Use hot and cold fomentation:

   • Applying heat to the affected parts can help minimize the stiffness and pain.
   • Go for a hot water bath or a regular bath with hot water in the morning or before going to bed. Using a hot water bottle or heating pad may also help in reducing the pain and stiffness.
   • Applying an ice pack to the affected area can give you relief.

4. Healthy diet

   • Eat a nutritious diet that contains ample proteins.
   • Include fresh fruits and vegetables in your regular diet.
   • Avoid animal protein in your diet.
   • Quit smoking and alcohol.

5. Manage your stress:

   • Take adequate sleep.
   • Try meditation, yoga, and other relaxation techniques.
   • Focus on positivity in your life.

Conventional Treatment for Ankylosing Spondylitis:

Commonly prescribed conventional treatment for ankylosing spondylitis is as follows:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs):

This is the first choice of treatment for ankylosing spondylitis. It reduces the pain, inflammation, and stiffness of the affected joints. Commonly used NSAIDs are:

• Naproxen
• Diclofenac
• Ibuprofen
• Indomethacin
• Meloxicam

NSAIDs have their own side effects, such as nausea, vomiting, pain in the abdomen, and bleeding due to the formation of an ulcer in the stomach.

2. Disease-modifying anti-rheumatic drugs (DMARDs)

If NSAIDs don’t give relief, stronger medicines like disease-modifying anti-rheumatic drugs (DMARD) which suppress your immune system and inflammatory reaction in the body are recommended.

• Methotrexate
• Sulfasalazine

These immunosuppressive medicines may give quick relief but the disease may return after stopping these medicines. These medicines have many side effects, and they are habit-forming. Blood tests are advised from time to time for patients, who are on these medicines for a long time, to keep a watch on their side effects.

3. Biologics: Tumor necrosis factor (TNF) blocker or an interleukin 17 (IL-17) inhibitor:

TNF blockers target a cell protein that causes the inflammation in your body. IL-17 plays a significant role in your body's defense against infection or inflammation. It helps to reduce pain, stiffness, and swelling of the affected joints.

Commonly prescribed TNF blockers and IL-17 inhibitors in ankylosing spondylitis are:

• Adalimumab
• Certolizumab pegol
• Etanercept
• Golimumab
• Infliximab

Chances of getting infections, such as tuberculosis, are higher when you are on these medicines.

4. Corticosteroids: Corticosteroids or steroids are prescribed in case of severe inflammation of the joints. Steroids may give you short-term relief in pain, swelling, and stiffness of the affected joints.

Our Experience in Treating Ankylosing Spondylitis at Life Force:

Dr. Shah’s extensive work in treating difficult diseases like ankylosing spondylitis over the last more than 39 years (since 1985) has helped several patients in over 180 countries. Dr. Rajesh Shah's research-based homeopathic treatment for ankylosing spondylitis is beneficial in treating ankylosing spondylitis along with the conventional mode of treatment.

We at Life Force have treated a few hundred cases of ankylosing spondylitis from different parts of the world. As per our experience, timely administration of homeopathic treatment helps significantly and it is strongly recommended in different stages of ankylosing spondylitis.  At Life Force, based on Dr. Rajesh Shah's experience and expertise, patients are guided about the prognosis of the disease and the scope of homeopathic treatment in ankylosing spondylitis.

Related Disease

• Rheumatoid Arthritis
• Pott’s Spine (Tuberculosis of the Spine)
• Lumbar Spondylosis
• Lumbar Spinal Stenosis
• Non-Specific Low Back Pain
• Osteoarthritis
• Degenerative Disc Disease