Ankylosing spondylitis

2.7M

people in the U.S. are living with ankylosing spondylitis (AS), that’s less than 1% of the U.S. population

1 in 4

spondyloarthritis patients have seen five or more health professionals in search of a diagnosis

20 to 40

Ankylosing spondylitis disease can occur at any age, but typically begins between ages 20 and 40 years of age

What is ankylosing spondylitis?

Ankylosing spondylitis (AS) is an autoimmune condition. Autoimmune conditions occur when the body’s immune system mistakes its own tissues for foreign invaders, such as bacteria or viruses. The confused immune system springs into action, seeking out to destroy the “invaders” in the tissues. 

In the case of ankylosing spondylitis, the immune system attacks the discs that make up your spine. This results in chronic inflammation in the spine which can lead to stiffness and pain.

Who is affected?

Anyone can be diagnosed with ankylosing spondylitis, but men are about two times more likely to get ankylosing spondylitis than women. The condition generally starts between the ages of 20 and 30 years old. [1] Ankylosing spondylitis diagnosis is more common among white Americans but black Americans and people in lower socio-economic status tend to have worse experiences of the condition (like more pain and depression). [1] [2]

Ankylosing spondylitis is often passed down genetically, from parents to their offspring. [3] People with the gene HLA-B27 have a higher risk of developing ankylosing spondylitis.

About six percent of the general population has this gene, and a blood test helps you determine whether you have it. (4) A positive test result means that you have proteins called antigens on your disease-fighting white blood cells, and that you are more at risk of developing ankylosing spondylitis. But not everybody with HLA-B27 develops the condition.

What happens in your body?

Common symptoms of ankylosing spondylitis include: [5]

  • Dull pain and stiffness in the lower back and buttocks, which is worse in the morning and gradually comes on over several weeks or months. Pain tends to ease after exercise or physical activity, not after rest. 
  • Pain or swelling in the heel or foot
  • Pain in your ribcage, such as when you exhale
  • Eye redness, pain, and sensitivity to light
  • Blurred vision
  • Diarrhea, bloating, or other gastrointestinal symptoms
  • Fatigue
  • Fever
  • Appetite loss

Over time, ankylosing spondylitis can cause the joints and bones of the spine to grow together (fuse). This can lead to stiffness, and result in a hunched-forward posture and difficulty breathing. You can prevent symptoms from getting to this point by managing it with appropriate treatments. 

How do I know if I have ankylosing spondylitis?

It is important to get an accurate diagnosis as quickly as possible to make sure that the condition does not worsen. The best way to do this is by visiting your doctor and, if possible, getting a referral to visit a rheumatologist, a doctor who specializes in treating ankylosing spondylitis.

Some ways that your doctor can assess whether you have the condition is through reviewing your medical history, and conducting a physical examination, lab tests (such as blood tests), and imaging tests (such as X-rays).

How is it treated?

There is no cure for ankylosing spondylitis, but integrative interventions have shown to reduce pain and discomfort and improve quality of life by slowing the condition’s progression and easing the severity of symptoms. [6] [7]

Integrative interventions offer a holistic approach to treatment. Instead of just conventional medicine, integrative treatments combine conventional medicine with nutritional tools, mind-body medicine, and manual medicine for a holistic approach to treating ankylosing spondylitis. 

For those new to integrative medicine, learn more here

Conventional Medicine

Many people with AS find that certain medications work for them and others do not. So, in order to find an effective conventional treatment, people with ankylosing spondylitis often work with their doctors to determine which medication works best with their body and needs. 

With the right medication, it is possible to manage symptoms like pain and inflammation and prevent the rapid worsening of the condition. Before starting to take any medication, be sure to ask your doctor about possible side effects. And if you notice any of the side effects once you start your treatment, let your doctor know as soon as possible.

Examples of conventional treatments:

  • Non-steroidal anti-inflammatory drugs (common name: ibuprofen), or NSAIDs, are commonly used treatments for inflammation and pain resulting from ankylosing spondylitis. Indomethacin is the NSAID of choice among many people with the condition. [8]

  • DMARDs (such as methotrexate) are a widely used drug for AS that intends to reduce pain, stiffness, and may prevent the progression of the condition. Janus kinase (JAK) inhibitors, such as tofacitinib, are newer DMARDs that may be promising for AS patients. [8]

  • Biologics (also known as biologic response modifiers) are a class of drugs used to treat ankylosing spondylitis. They have shown to slow the worsening of AS. [8]

Mind-Body Medicine

Research shows that gentle, low-intensity mind-body treatments can help AS patients with mobility, mood, decreased pain, and more. There are a wide variety of mind-body treatments for ankylosing spondylitis, ranging from deep breathing to aqua-therapy.

When living with chronic pain, engaging in regular movement and exercise may feel difficult and unnecessary. But doing so can actually improve your symptoms. 

Before starting a physical exercise regimen, consult with your doctor about what might be the best activities for you and your body.

Examples of mind-body medicine:

  • Tai chi is a Chinese practice of slow, low-intensity movements that researchers have found can improve disease activity and flexibility for patients with ankylosing spondylitis.

  • Pilates and Yoga come in many different styles, often engaging both the body and the mind through controlled breathing and stretching. Several studies suggest that they improve physical functionality (including balance and flexibility) and should be commonly used to improve dysfunction in patients suffering from  ankylosing spondylitis.

  • Aqua-therapy and warm water exercise can help you stay active without aggravating your joints, and is particularly useful for individuals who have difficulty with other forms of physical exercise. Research shows aquatic exercises can relieve pain and improve physical functionality in RA patients; this may suggest some help and improvement in patients living with ankylosing spondylitis.

  • Gentle exercise programs guided by instructors who understand your condition can help you both lose weight and manage your symptoms. Weight loss has shown to relieve pressure on your knees and curb pain-causing inflammation.

  • Relaxation therapies like deep breathing techniques, meditation, and biofeedback can help patients ease anxiety and better manage chronic pain. UCLA researchers suggest that mind-body treatments like these can disrupt inflammatory pathways in the body and are anti-inflammatory.

Manual Medicine

Manual treatments are administered by certified clinicians, using physical pressure and stimulation on the body to reduce ankylosing spondylitis symptoms. Treatments can vary in intensity and incorporate other elements such as heat and aromatherapy to enhance relief.

Examples of manual medicine:

  • A widely-adopted Chinese treatment administered by certified acupuncturists who insert very thin needles at strategic points on the body to support overall wellness. Some research presents acupuncture alongside cupping therapy as a more effective therapy for patients living with AS.

  • Licensed massage therapists use different techniques, like shiatsu, hot stone, and Swedish massage, to provide temporary pain relief. Studies suggest promising results that massage therapy may be useful for patients living with AS. 

  • Physical therapy can help with physical strengthening, mobility, and overall functionality. Licensed therapists provide one-on-one treatment and teach patients self-management techniques so that they can improve their condition on their own too.

Nutritional Tools

Nutrition plays a crucial role in your overall health, and is a tool you can use to combat joint damage, reduce inflammation, and manage other ankylosing spondylitis symptoms. 

Just like with conventional, mind-body, and manual medicines, there is not one ideal treatment for every AS patient. When selecting nutritional tools to treat your condition, it is best to consult with your doctor or work with a dietitian, naturopath, or nutritionist to find out the best diet for you.

Examples of nutritional tools:

  • Anti-inflammatory diets

    • Anti-inflammatory diets include nutrient-dense foods that contain antioxidants and intend to reduce inflammation in the body. A popular anti-inflammatory diet is the Mediterranean diet which has been shown to reduce signs of inflammation

  • Plant-based diets

    • Vegetarian and vegan diets have shown to promote gut health, which may have an anti-inflammatory impact.

  • Elimination diet

    • While some foods can help reduce RA symptoms, other foods may trigger them. An elimination diet, which is an eating plan that eliminates certain foods or food groups believed to be causing negative bodily reactions, can help you figure out which foods are triggering those symptoms and bring you closer to your ideal diet.

  • Fish

    • Research suggests that eating fish reduces overall inflammation in adults.

    • Recommendation: Eat three to four ounces of fish (salmon, tuna, sardines, anchovies, or other cold-water fish) twice a week.

  • Fruits and vegetables

    • Fruits and vegetables have antioxidants, which support your immune system and may fight inflammation.

    • Recommendation: Eat one and a half to two cups of fruit (like blueberries, blackberries, cherries, and strawberries) and two to three cups of vegetables (like spinach, kale, and broccoli) per meal.

  • Nuts

    • Nuts are rich in healthy fat, protein, and fiber, and help fight inflammation.

    • Recommendation: Eat one and a half ounces–about a handful–of nuts (like walnuts, pine nuts, pistachios, and almonds) per day.

  • Beans

    • Beans (like red, pinto, navy, and black beans) are rich in fiber and protein, and are full of both antioxidants and anti-inflammatory properties.

    • Recommendation: Eat at least one cup of beans per week.

  • Olive oil

    • This heart-healthy ingredient contains healthy fat, antioxidants, and oleocanthal, an anti-inflammatory compound.       

    • Recommendation: Consume two to three tablespoons of extra virgin olive oil per day by using it in your cooking or salad dressings.

  • Onions

    • These simple, flavor-rich vegetables are packed with antioxidants and may help reduce inflammation, improve heart health, and help control cholesterol levels.

  • Fiber

    • Fiber is found in foods like beans, whole grain breads, and fresh vegetables. It makes you feel fuller for longer and boosts digestive health. It also may help reduce inflammation.

    • Recommendation: Incorporate a good mix of insoluble fiber (from vegetables, wheat, and seeds) and soluble fiber (from fruits and oats) in your diet or try fiber supplements.

  • Fish oils

    • Fish oils may help reduce inflammation. Research has demonstrated that fish oils have the capacity to decrease the disease activity of AS and may be useful for patients.

  • Turmeric

    • Research shows that a key chemical compound (curcumin) in turmeric can relieve rheumatoid arthritis and its symptoms. This may suggest its efficacy in reducing inflammation in ankylosing spondylitis.

  • Bromelain

    • Bromelain is found in pineapples and is a proteolytic enzyme that helps regulate the inflammation pathway. Research suggests it is safe to be used and may help reduce inflammation.

  • Vitamin D

    • Vitamin D supplements are good for bone health, and they can also help keep the immune system functioning properly.

  • Antioxidants

    • Selenium supplements can help keep your immune system functioning properly and prevent cell damage (also known as oxidative stress).

    • Research shows other antioxidants that can help prevent cell damage and keep the body in a balanced state. The antioxidant quality of pomegranates may ease symptoms such as tender joints.  

  • Probiotics

    • Chronic conditions and medications can have a negative impact on gut health. Research on the effects of probiotic supplements have shown that they may help improve gut health and even lead to lower levels of inflammation.

  • Green tea extract

    • Research on green tea extract (GTE) may help reduce overall inflammation and joint damage in patients with rheumatoid arthritis. This suggests that it may reduce inflammation in tendinitis and bursitis.

  • [1] Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/. Published March 27, 2019. Accessed July 27, 2020. 
  • [2] Roussou E, Kennedy LG, Garrett S, Calin A. Socioeconomic status in ankylosing spondylitis: relationship between occupation and disease activity. J Rheumatol. 1997;24(5):908-911. 
  • [3] Tsui FW, Tsui HW, Akram A, Haroon N, Inman RD. The genetic basis of ankylosing spondylitis: new insights into disease pathogenesis. Appl Clin Genet. 2014;7:105-115. Published 2014 May 22. doi:10.2147/TACG.S37325 
  • [4] Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum. 2012;64(5):1407-1411. doi:10.1002/art.33503 
  • [5] Ankylosing spondylitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808. Published November 8, 2019. Accessed July 27, 2020. 
  • [6] Edavalath M. Ankylosing spondylitis. J Ayurveda Integr Med. 2010;1(3):211-214. doi:10.4103/0975-9476.72619 
  • [7] Zão A, Cantista P. The role of land and aquatic exercise in ankylosing spondylitis: a systematic review. Rheumatol Int. 2017;37(12):1979-1990. doi:10.1007/s00296-017-3829-8 
  • [8] Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/. Published March 27, 2019. Accessed July 27, 2020. 
  • [9] Reveille, J. D., Witter, J. P., & Weisman, M. H. (2012). Prevalence of axial spondylarthritis in the United States: Estimates from a cross-sectional survey. Arthritis Care & Research, 64(6), 905-910. doi:10.1002/acr.21621 
  • [10] Spondylitis Association of America - Ankylosing Spondylitis. (2020, September 01). Retrieved July 12, 2020, from https://spondylitis.org/ 
  • [11] Axial Spondyloarthritis. (n.d.). Retrieved July 12, 2020, from https://www.arthritis.org/diseases/ankylosing-spondylitis 
The information on this page is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek medical advice from your physician or health provider for your specific needs.