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Ankylosing Spondylitis: Oh, My Aching Back!

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Back pain is one of the most common reasons to see a doctor. Chronic back pain can be a symptom of ankylosing spondylitis, a form of arthritis that often starts before age 40.

Spondylitis means inflammation of the spine, and ankylosing means growing together, or fusing. In advanced cases, the vertebrae grow new bone which fuses the spine in a fixed, immobile position. Thus it is important to get early diagnosis and treatment. Unfortunately, diagnosis is typically made five to seven years after the disease process begins. It is a challenge for primary care medicine to identify which patients need a referral to a rheumatologist.

Ankylosing spondylitis generally begins in the age range of 15 to 35 years old, but it can also start in children or older adults. Inflammation affects primarily the back and sacroiliac joint, but it can also spread to other joints and organs, including the eyes and intestines. Pain in the lower back and buttocks are typically the first symptoms. Morning stiffness is common. The symptoms generally improve with exercise. About 75 percent of patients show good or very good response to non-steroidal anti-inflammatory drugs within 48 hours.

Treatment options include the following:
1. Medication,
2. Exercise and physical therapy,
3. Good posture practice,
4. Heat/cold to relax muscles and reduce joint pain,
5. Acupuncture,
6. Chiropractic,
7. Massage,
8. Transcutaneous electrical nerve stimulation,
9. Yoga,
10. Chinese herbal medicine,
11. Surgery, including knee and hip replacement.

Medication includes several different approaches to modifying the inflammatory process. Options include:

1. Non-steroidal anti-inflammatories. These are the old stand-by drugs aspirin, ibuprofen, naproxen, indomethacin, celecoxib, diclofenac, misoprostol, and meloxicam. They inhibit the action of cyclooxygenase (COX) in producing prostaglandins.

2. Corticosteroids. These are the steroidal anti-inflammatories, which are more powerful but also carry higher risks of side effects.

3. Sulfasalazine. This is used for arthritis and inflammatory bowel disease.

4. Methotrexate. Originally developed to treat cancer, this chemotherapy drug is used in smaller doses to treat rheumatoid arthritis and ankylosing spondylitis.

5. Tumor necrosis factor (TNF) inhibitors. These are proteins known as biologic drugs, which must be injected.

The Spondylitis Association of America offers detailed information and news on its web site: Spondylitis.org/.

Kain T et al, “Evidence-based recommendations for the diagnosis of ankylosing spondylitis: results from the Australian 3E initiative in rheumatology”, Med J Aust. 2008 Feb 18; 188(4): 235-7.

TNF inhibitor drugs:

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

Add a Comment9 Comments

EmpowHER Guest

The average time of diagnosis for women is 10 YEARS after start of disease. That is a fact. Many times nothing shows up on x-rays, MRI's etc until the damage is done. Getting a doctor to take you seriously about your back pain is another problem so they don't bother ordering a MRI until again, it is too late. All the official research sites strongly discourage chiropractic manipulation. Though I follow the anti inflammatory diet unfortunately, it is not enough to reduce the disease inflammation.

April 6, 2010 - 4:36am
EmpowHER Guest

Physicians (and chiropractic physicians) are well qualified to diagnosis EARLY AS from exams, symptom patterns, MRIs, Xrays, and blood tests. |For those who do not think chiropractic can contribute to sucessful management of AS, below are two research articles of successful cases. Many AS patients benefit from gentle manipulative therapy. |And the earlier commenter is correct: anti-inflammatory diet changes (basically lots of natural foods, fresh fruits and vegetables, anti-oxidants, etc) are recommended for an inflammatory arthrosis of any kind. Consider the following website for more information on an preventative healthful diet: www.deflame.com. |Good luck all- Dr. Michelle |Article sources:
1. J Manipulative Physiol Ther. The effect of chiropractic care for a 30-year-old male with advanced ankylosing spondylitis: a time series case report. 2003 Oct;26(8):E1-9.
2. J Can Chiropr Assoc. Symptomatic improvement in function and disease activity in a patient with ankylosing spondylitis utilizing a course of chiropractic therapy: a prospective case study. 2005 Jun;49(2):81-91.

April 5, 2010 - 8:57pm
EmpowHER Guest

The problem is there is no way to tell what is EARLY disease. It is extremely dangerous to do anything to the spine if you have ankylosing spondylitis. It is a similar problem with diet and supplements, there is no particular diet that helps everyone. The disease can come and go on it's on for many years. I thought I "cured" myself several times until it came back severe. Yes, check the references at the official site for AS.

April 4, 2010 - 2:57pm

Check the reference to the Spondylitis Association web site: http://spondylitis.org

April 4, 2010 - 11:39am
EmpowHER Guest

hi diet changes n supplements??? could you put some more light o it please..!

April 4, 2010 - 10:22am
EmpowHER Guest

Treatment/Therapy for Chiropractor really works well for musculoskeletal problems and nerve related problems. Though this method working well your chiropractor should be an experienced and registered also with govt. approved association. Chiropractors are available locally you can found one of them nearby you.
(Link to website removed by EmpowHER moderator.)

April 3, 2010 - 6:29am
EmpowHER Guest

Chiopractic care has help me with my neck and upper back. I was diagnosed with AS 4 years ago. Diet change and supplements have also done wonders for me!

March 31, 2010 - 2:02pm

Thank you for this comment. My understanding is that chiropractic may be helpful in the EARLY stages, before significant fusion occurs.

March 30, 2010 - 8:25pm
EmpowHER Guest

Chiropractic treatments ARE NOT recommended. The fusing in the spine causes some areas to be very weak. Any movement can cause it to break easily. Relief from NSAIDs does not mean the disease is slowed.

March 30, 2010 - 8:06pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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