Ankylosing spondylitis is also known as Marie-Strumpell disease or Bechterew’s disease. It’s a form of inflammatory arthritis that primarily affects your spine. After several years, the bones in the spine, called vertebrae, may fuse together. When this happens, the spine becomes stiff and less flexible.
- Ankylosis: joints fuse together and become unmovable
- Spondylitis: inflammation involving the spine’s vertebrae and facet joints
AS often develops in the sacroiliac joints (SI joints), which connect your lower spine to your pelvic bones. It can also develop in other parts of your spine and cause symptoms and conditions elsewhere in your body.
Sometimes, Ankylosing spondylitis can affect your posture. For example, you may develop a hunched back called as kyphosis, an abnormal forward position of the upper spine.
Symptoms
The pain normally becomes persistent (chronic) and is felt on both sides, usually persisting for at least three months. Over the course of months or years, the stiffness and pain can spread up the spine and into the neck. Pain and tenderness spreading to the ribs, shoulder blades, hips, thighs and heels is possible as well.
General symptoms:
- Difficulty bending the spine
- Pain in the hips and difficulty walking- dull diffuse type of pain
- Pain in the heels and soles of the feet- pain in worse in morning and night and better after a warm shower
- Bent-over posture
- Straightening of the normal curvature of the spine
- Fever- In the early stages of disease, there may be mild fever, loss of appetite and general discomfort
- Loss of appetite, weight loss
- Fatigue, decreased energy
- Eye swelling, redness and pain
- Sensitivity to light
- Difficulty taking a deep breath (because expanding the chest is difficult and painful)
- Heart failure
- Pain and stiffness. Constant pain and stiffness in the low back, buttocks, and hips that continue for more than three months. Back pain from ankylosing spondylitis is inflammatory in nature
- The stiffness is often worst in the morning and after you have been inactive for a while
- Bone fusion resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture
- Pain in ligaments and tendons.
Causes
The tendency to develop ankylosing spondylitis is believed to be genetically inherited, and a majority (nearly 90%) of people with ankylosing spondylitis are born with a gene known as the HLA-B27 gene.
However, the HLA-B27 gene appears only to increase the tendency of developing ankylosing spondylitis, while some additional factor(s), perhaps environmental, are necessary for the disease to appear or become expressed.
Scientists suspect that other genes, along with a triggering environmental factor, such as a bacterial infection, are needed to trigger AS in susceptible people.
Risk factors
- Family history: A family history of ankylosing spondylitis is a risk factor, along with the presence of the HLA-B27 protein. According to a 2002 study, more than 90 percent of people who receive a diagnosis of this condition have the gene that expresses this protein.
- Age: Unlike other arthritic and rheumatic disorders, initial symptoms of ankylosing spondylitis often appear in younger adults. Symptoms often appear between ages 20 and 40.
- Sex: Ankylosing spondylitis is around three times more common in males but is seen in females as well.
Complications
In severe ankylosing spondylitis, new bone forms as part of the body’s attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae. Those parts of the spine become stiff and inflexible. Fusion can also stiffen the rib cage, restricting your lung capacity and function.
Other complications might include:
- Eye inflammation (uveitis). One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision.
- Compression fractures. Some people’s bones thin during the early stages of ankylosing spondylitis. Weakened vertebrae can crumble, increasing the severity of your stooped posture. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spine.
- Heart problems. Ankylosing spondylitis can cause problems with your aorta, the largest artery in your body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function.
Diagnosis
- Imaging
- X RAY: The x-rays are supposed to show erosion typical of sacroiliitis. Sacroiliitis is the inflammation of the sacroiliac joints. However, it may be several years before these signs appear.
- MRI SCAN: A magnetic resonance imaging (MRI) scan may highlight changes in your sacroiliac joints that might not show up on an X-ray. It may also show any inflammation of ligaments in the spinal region.
Bamboo spine: Bamboo spine is a radiographic feature seen in ankylosing spondylitis that occurs as a result of vertebral body fusion. It is often accompanied by fusion of the posterior vertebral elements as well and resembles a bamboo stem; therefore, the term bamboo spine.
- Blood investigations: A blood test can show if there’s inflammation in the body, but only if the condition is in an active phase. They are:
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Plasma viscosity (PV)
Homeopathic management
Homeopathic treatment treats the disease internally and tries to correct the altered immune system. It reduces the pain, stiffness, 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.
Homeopathic medicines
Aesculus Hippocastanum
The prominent symptom indicating the use of Aesculus Hippocastanum is a pain in the sacrum and the hips. Along with this, there is marked stiffness in the lower back. The symptoms get worse from rising from the seat, and the person has to make repeated efforts. At that time, there is a sensation as if the back would break. Aching pains in the lumbar, sacral and the pelvic region are treated well with homeopathic medicine Aesculus Hippocastanum.
Kalmia Latifolia
It is indicated when there is a constant pain in the spine. Pain in the lumbar area and a burning/heat sensation in the lumbar spine is present. A feeling of lameness in the back is present. Sometimes there is a sensation as if the back would break. There is also an intense pain in the neck (cervical spine) along with stiffness. The neck feels tender to the touch. Kalmia Latifolia is an effective homeopathic remedy for the pain in the neck (cervical spine) that radiates to the shoulders. Early morning worsening of neck pain and stiffness is also present.
Rhus Tox
Rhus Tox is a well indicated medicine for ankylosing spondylitis. It helps in reducing the stiffness of the back. The stiffness is most intense in the morning. Sitting also aggravates the stiffness. Rhus Tox also works wonders in reducing back stiffness that gets worse from taking rest. Here lying or sitting still worsens the stiffness. The person requiring Rhus Tox gets relief by walking. Pain in the lower back is also severe along with stiffness. Rhus Tox is also a natural medicine for managing back pain which gets relieved by the application of hard pressure.
Colocynthis
For using Colocynthis hip pain may be cramping, drawing or tearing in nature. The pain from hip may also extend down to the knee, leg or even to the feet in a few cases. Sensitivity to touch the affected hip is also seen in many cases. Colocynthis is also a useful remedy for hip pain that gets better by lying on the affected side. In some cases, pressure on the affected hip offers comfort. Hip pain that gets better by warmth also indicates the use of homeopathic medicine Colocynthis. The person needing Colocynthis also experiences an aggravation of hip pain by sitting, standing, being in motion, and gets relief from rest.
Bryonia Alba
A backache that is worse from motion or walking is the guiding feature to use Bryonia Alba. In a few cases, stooping, standing and sitting also worsen the backache. The relief in back pain is afforded only with absolute complete rest. Stiffness is also present along with a backache. The stiffness is so intense that a person has to sit and walk in a stooped posture. Maintaining an upright posture while sitting/walking is difficult.
Agaricus Muscarius
Agaricus Muscarius is majorly used in ankylosing spondylitis when the spine is sensitive to touch, along with pain. The sensitivity of the spine is severe in the morning. Other symptoms pointing towards the use of Agaricus Muscarius are back pain getting worse from stooping, a burning sensation in the spine, and a feeling of tightness in the back muscles. A lumbosacral backache that is worse during daytime exertion is also treated well with Agaricus Muscarius. A marked stiffness in the back is present along with pain. There is a sensation as if the back would break. Another sensation that may appear is that of a cold or hot needle piercing the back.
Kali Carb
Kali Carb is a medicine is used to treat ankylosing spondylitis where weakness in the lower back accompanies back pain. The pain is present in the lower back, hips, and the thighs. The person feels better by lying down. Homeopathic medicine Kali Carb is also helpful when there is difficulty in turning in bed from a backache. Another chief indication to use Kali Carb is a sharp pain in back extending up and down.
Natrum Mur
Natrum Mur is another valuable medicine used to treat ankylosing spondylitis. The characteristic feature to use Natrum Mur is relief from back pain upon lying down, especially on a hard surface. Other symptoms include difficulty in stooping, a pulsating sensation in the back and pain in the sacrum. The person needing homeopathic medicine Natrum Mur may also need firm support on the back.
Cimicifuga Racemosa
Cimicifuga Racemosa is used to treat neck (cervical back) pain and stiffness in cases of ankylosing spondylitis. A contracted sensation in the neck is present, and the neck is sensitive to touch. Pressure seems to worsen the pain in the neck. Any motion of the head and hands also aggravates the neck pain. Worsening of neck pain from exposure to cold air is also treated well with homeopathic medicine Cimicifuga Racemosa.
Calcarea Fluor
Calcarea Fluor is a well indicated medicine for dissolving osteophytes (bony outgrowths appearing in the spine) in cases of ankylosing spondylitis. Another symptom that suggests the use of Calcarea Fluor is a back pain that is worse from rest and better from motion. Application of warmth may also relieve back pain in a few cases. Restlessness along with back pain is also present.
Tellurium Met
Tellurium Met is a medicine for ankylosing spondylitis with marked sacral pain radiating down the thigh. The back is sensitive, and the pain gets worse from touch. A feeling of weakness in the back, and cervical back pain spreading to the shoulder and between the scapulae are other symptoms that indicate the need for this medicine. The cervical spine is also sensitive to pressure and touch.
Conium Maculatum
Conium Maculatum is indicated when there is a severe aching in the sacral region from walking a short distance. Stitching pain in the sacrum when standing, weakness and lameness in the small of the back, tightness in the nape of the neck with pain and stiffness and soreness in the lower cervical spine are also present. Pain in the dorsal back between the shoulders and the lumbar region also indicates the need for this medicine.
Guaiacum
Marked stiffness in the neck is the key feature to use this medicine. Pain in the neck and the back (between scapulae) is also treated well with this medicine. It is also indicated in some cases where neck pain radiates down the sacrum.