Top 10 to Manage Ankylosing Spondylitis


Top 10 Tips for Management of Ankylosing SpondylitisAnkylosing spondylitis occurs predominantly in men (two to three times more common in males than in females), women can and do develop the disease. 

Ankylosing Spondylitis is a systemic auto-immune disorder, becoming apparent in the form of  swelling and irritation in the vertebral joints as well as stiffness  and pain in the back. Some patients may experience only episodes of transient back pain while some others may experience long standing and severe back pain. If this problem is not treated properly, it could cause small bony outgrowths from the edges of the vertebrae. When it involves more than two vertebrae, a person can become disabled.

Those who have chronic, severe inflammation of the spine can develop a complete bony fusion of the spine (ankylosis). Once fused, the pain in the spine disappears, but the affected individual has a complete loss of spine mobility.



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. Recently, two more genes have been identified that are associated with ankylosing spondylitis. These genes are called ARTS1 and IL23R. These genes seem to play a role in influencing immune function. Early diagnosis can be difficult but is important; magnetic resonance imaging of the sacroiliac joints can be helpful in early disease.

Symptoms could be varied ranging from inflammation in the spine, joints and other organs of the body.     

The treatment of ankylosing spondylitis typically involves the use of medications to reduce inflammation and/or suppress immunity to stop progression of the disease, physical therapy, and exercise. Physical therapy and exercise help improve posture, spine mobility, and lung capacity.

Use of  (NSAIDs) to Decrease Pain and Stiffness of the Spine and Other joints: Commonly used NSAIDs include indomethacin (Indocin), tolmetin (Tolectin), sulindac (Clinoril), naproxen (Naprosyn), and diclofenac (Voltaren). The decision on which NSAID to use should be on an individual patient basis taking into account risk factors, particularly for gastrointestinal and cardiovascular disease. Analgesics, including paracetamol and opioids, may be considered when NSAIDs are contraindicated or not tolerated.


Top 10 Tips for Management of Ankylosing SpondylitisMaintenance of Proper Posture: This includes deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Since ankylosis of the spine tends to cause forward curvature, patients are instructed to maintain erect posture as much as possible and to perform back-extension exercises. Better posture makes you feel better in yourself and reduces feelings of self consciousness.

Sleeping Posture: Avoid use of pillow and sleep on a firm mattress to prevent spine curvature. Sleeping on the abdomen (prone) or on the back is better than sleeping sideways. This helps prevent spinal & hip deformity in the long run.


Exercise: is the single most important thing you can do to help yourself. The benefits of exercise include increased flexibility, range of motion, posture and reduced stiffness- the more flexible you are the easier it is to do everyday tasks such as putting on your socks or reaching something on a high shelf.  Swimming is especially good. Deep breathing for several minutes each day will help to keep the joints between your spine and ribs mobile. Pilates has been suggested as a form of exercise to manage ankylosing spondylitis by a recent study " We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients."  In order to enhance the muscle power, several strengthening exercises (low weights and high repetitions) should be performed. This would help a person to stay upright as well as erect. Apart from this, gentle stretching exercises are useful. This would help the person to prevent stiffness as well as changes in posture.


Avoid Wearing a Corset or a Brace: These often make matters worse, as they hold the spine rigid. Anything that supports the back will allow the muscles to become weak, and the back will then become more prone to pain and stiffness. And with ankylosing spondylitis (AS), not moving leads to not being able to move.




Top 10 Tips for Management of Ankylosing Spondylitis

Eat Well:  Eat a good nourishing diet with plenty of proteins. Eat fruit and veggies and also drink milk.  Use fat (especially saturated fat found in animal products), cholesterol, sugar, and salt in moderation. Drink 8-10 glasses of water a day. Avoid putting on extra weight. Extra weight puts additional stress on joints and bones. For example, the corticosteroid prednisone causes weight gain to some degree in nearly all patients who take the medication and can lead to redistribution of body fat to places like the face, back of the neck, and abdomen.



Inflammation and diseases in other organs are to be  treated separately: For example, inflammation of the iris of the eyes (iritis or uveitis) may require cortisone eyedrops (Pred Forte) and high doses of cortisone by mouth. Additionally, atropine eyedrops are often given to relax the muscles of the iris. Sometimes injections of cortisone into the affected eye are necessary when the inflammation is severe. Heart disease in patients with ankylosing spondylitis, such as heart block, may require a pacemaker placement or medications for congestive heart failure.


Try Heat or Cold: Various forms of heat will help to relieve pain and stiffness. Hot bath / or shower first thing in the morning and / or before bed reduces pain and stiffness, especially if some stretching exercises are done at the same time. Hot weather bottles or electric blankets are quite useful in bed. For a particularly inflamed area, an ice-pack or bag of frozen peas wrapped in a damp tea towel may help.



Top 10 Tips for Management of Ankylosing SpondylitisLifestyle Modification is a must for women with ankylosing spondylitis  both in their  day-to-day activities and at workplace. For example, workers can adjust chairs and desks for proper postures. Drivers can use wide rearview mirrors and prism glasses to compensate for the limited motion in the spine. The ideal chair at home or at work has a firm seat and an upright, firm back, preferably extending to the head. The chair should be of a height which will allow you to keep a right angle with the knee and hip joints. Whatever you do, avoid low, soft chairs and sofas as they will encourage bad posture and increase pain. Try not to sit for too long. Stand up, walk about and limber up.


Cigarette Smoking: is strongly discouraged in people with ankylosing spondylitis, as it can accelerate lung scarring and seriously aggravate breathing difficulties. Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes. The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

Pregnancy in women with ankylosing spondylitis does not usually involve any special problems for mother or baby. However, some medications can be harmful to unborn children. If you are pregnant or planning to become pregnant, you will need to discuss the use of medication with your doctor.  


Dated 21 February 2012


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