DEFINITION

Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis which causes calcification of the spine and adjacent structures and commonly progresses to eventual fusion of the involved joints.

DESCRIPTION

There is a loss of movement with a progressive stiffening of the spine and a forward stooped posture. There may be involvement of systems other than the musculoskeletal system including the eyes, heart, bowel, skin and nervous system. Ankylosing Spondylitis is 3 times more common in men than in women and usually begins between the ages of 20 and 40. A family history is commonly seen in cases of AS.

SIGNS AND SYMPTOMS

Lower back pain and stiffness sometimes radiating to the buttocks or thighs are the symptoms most commonly experienced with AS. In some cases, stiffness in a leg or arm joint may be the first sign of AS. The condition usually develops gradually with periods when the person is free of symptoms. The symptoms are generally worse in the early morning and after periods of inactivity. Back pain is relieved by flexing the spine which often results in the person developing a 'bent-over' posture.

Chest pain aggravated by breathing may be experienced as a result of the joints connecting the ribs to the spine (costovertebral) being affected by AS. As the disease progresses, stiffness increases throughout the spine and the extent to which the person can expand his/her chest decreases. fever - adults, fatigue, anorexia, weight loss, anaemia and uveitis (inflammation of the eyes) are also symptoms associated with AS. In rare cases other systems of the body may be affected such as the nervous and cardiovascular systems.

TREATMENT OPTIONS

As with all conditions your Doctor should be consulted. Your Doctor can diagnose and treat this condition. The diagnosis involves a blood test followed by an X-ray. A person with AS will usually experience flare-ups followed by symptom-free periods. In most cases, with proper treatment, the patient can live a normal, productive life with little, if any, disability. The majority of people with AS are able to remain in employment without significant loss of time from work.

The principles of treatment are to relieve pain and stiffness, maintain mobility and avoid the development of deformities. In the early stages of AS, exercises are given to promote proper posture and joint motion. The object is to build up muscle groups that oppose the direction of the deformities i.e., to strengthen the muscles which help to extend rather than flex the spine. Non steroidal anti-inflammatory drugs (NSAIDs) are used to relieve symptoms by reducing joint inflammation and pain but do not alter the course of the disease. Radiotherapy is occasionally indicated if the response to drug therapy is unsatisfactory.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) Follow the Diet Hints.
2) Your Doctor may recommend that you take NSAIDs to help relieve joint inflammation and pain. If you have any queries regarding your medication, ask your Pharmacist for advice.
3) It is very important to exercise every day to keep the joints mobile and muscles toned. Follow the exercise routine recommended by your Doctor or Physiotherapist. Patients who adhere to a treatment programme in the early stages of AS are usually able to continue living a normal life free from disability.
4) Avoid activities which place a heavy amount of stress on the joints e.g., cutting thick products or lifting heavy items etc.
5) Being very overweight can place excessive strain on the joints. If you need to lose weight ask your Pharmacist or Doctor for advice. (See the Weight Management - Meal Plan topic).
6) Massage, relaxation, exercise, liniments and joint wraps may also help to relieve the symptoms of the disease. Ask your Pharmacist for advice.
7) See the nutritional supplements recommended in the Vitamins,/Minerals/Herbs section of this topic. Ask your Pharmacist for advice.

DIET HINTS

- Dietary changes which assist in reducing inflammation in the joints may be of some benefit to a person with Ankylosing Spondylitis.
- The diet should be rich in oily fish (salmon, tuna, mackerel, mullet) which contain anti-inflammatory essential fatty acids. Foods high in Vitamin C e.g., apples, pears, berries, pawpaws etc., may help to maintain healthy connective tissue. Foods such as tripe, oats, irish moss, shark fin soup and mussels are rich in proteoglycans which help to nourish and restore cartilage.
- Fresh, natural yoghurt is a good source of acidophilus bacteria which is needed to maintain a healthy bowel and digestive system.
- Foods rich in silicon can be beneficial for arthritis sufferers. These include wholegrain cereals, hard nuts, seeds and apple.
- Ginger has anti-inflammatory effects and can be included in cooking and fresh juices.
- The diet should be low in saturated fats, so avoid fatty and fried foods, commercial pastries, and chocolate. Avoid acid forming foods such as red meat and sugar as these may also promote inflammation. Tea and coffee, especially when taken with meals, can interfere with the absorption of nutrients.
- Weight control is usually essential to minimise the load on inflamed joints.
- Joint inflammation may be aggravated by certain groups of food such as the "nightshade" vegetables (potato, tomato, aubergine, chilli and peppers) and salicylate-rich foods (see the Low Salicylate Diet topic on the Healthpoint).

VITAMINS/MINERALS/HERBS

Some nutritional supplements may be considered if the diet is inadequate.
- A daily multi-vitamin which includes the antioxidant nutrients, vitamin A, vitamin C, vitamin E, beta carotene and zinc may help to boost the natural immune system of the body.
- Omega-3 fatty acids (fish oil capsules) have shown to be of benefit in a 12 month study of people with inflamed joints.
- If you suffer from bloating, flatulence and generally poor digestion, an acidophilus supplement may be beneficial.

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