Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the spine and sacroiliac joints, and to manage its impact, recognition of symptoms, early diagnosis, and appropriate treatment that includes medication, exercise, and, in some cases, surgery are essential.
What is ankylosing spondylitis?
Ankylosing spondylitis (AS), also known as ankylosing spondylitis, is a chronic inflammatory disease that predominantly affects the spine and sacroiliac joints. It is part of the group of rheumatic diseases called seronegative spondyloarthropathies. The disease can lead to fusion of the vertebrae (ankylosis), causing severe stiffness and loss of flexibility in the spine.
How does ankylosing spondylitis affect the body?
Ankylosing spondylitis affects the body by causing chronic inflammation in the spine and joints, which can lead to pain, stiffness, limited mobility and, in advanced cases, bone fusion and posture deformity.
Types of spondylitis and manifestations
Spondylitis is an inflammatory condition that affects the joints of the spine, causing pain and stiffness. There are several types of spondylitis, each with different characteristics and manifestations.
Axial spondylitis
Axial spondylitis mainly affects the spine and joints, manifesting itself through chronic back pain, morning stiffness.
Peripheral spondylitis
On the other hand, peripheral spondylitis involves joints outside the spine, such as the hips, knees and shoulders, and is characterized by pain, swelling and stiffness.
Causes of ankylosing spondylitis
Ankylosing spondylitis is a chronic inflammatory disease that mainly affects the joints of the spine and pelvis. The exact causes of this disease are not fully understood, but a combination of genetic, immunological and environmental factors are thought to play an important role in its development.
Genetics and the role of HLA-B27
One of the most important genetic factors involved in the development of ankylosing spondylitis is the presence of the HLA-B27 gene. This gene is part of the immune system and is associated with an increased risk of developing the disease. Almost 90% of people with ankylosing spondylitis carry this gene, although not all carriers of HLA-B27 develop the disease. This suggests that HLA-B27 is a major risk factor, but not enough on its own to cause the disease.
Immune system disorders
Ankylosing spondylitis is an autoimmune disease, meaning that the body's immune system attacks its own healthy tissues, especially the joints. It is thought that an abnormal immune system response to infections or other stimuli can lead to inflammation of the joints and, over time, their fusion. In addition, chronic inflammation can contribute to the deterioration of the tissues and bones that make up the spine and joints.
Environmental factors and infections
Environmental factors, such as bacterial infections, are also thought to be factors that can trigger or worsen ankylosing spondylitis in genetically predisposed individuals. Infections of the intestinal tract or urogenital system are particularly relevant, as certain bacteria, such as Klebsiella pneumoniae, have been associated with an increased risk of developing the condition. Thus, chronic infections or inflammation may interact with genetic predisposition and contribute to the development of the disease.
Risk factors for ankylosing spondylitis
Ankylosing spondylitis is a complex condition, and certain risk factors may increase the likelihood of developing the disease. Although the exact cause is not completely known, it is known that certain genetic, demographic, and environmental characteristics play an important role in its occurrence.
Genetics
The presence of certain genes plays a major role in the risk of developing ankylosing spondylitis. The most significant genetic factor is the presence of the HLA-B27 gene, which is found in approximately 90% of people affected by the disease. Although not all carriers of HLA-B27 develop ankylosing spondylitis, this genetic marker significantly increases the risk.
Gender and age
Ankylosing spondylitis is more common in men than in women, and the age of onset is usually between 15 and 30 years. Men have a more severe form of the disease, and symptoms may appear earlier and progress more rapidly. Women, on the other hand, may develop the disease later in life and may have milder symptoms or be less affected by complications. Hormonal factors and differences in immune response between the sexes may influence this risk.
Symptoms of Ankylosing Spondylitis
Ankylosing spondylitis is a chronic inflammatory disease that affects the joints of the spine and pelvis, but can also involve other peripheral joints. It causes a range of symptoms that can vary depending on the severity of the disease and its stage.
Back pain and stiffness
One of the most common and early symptoms of ankylosing spondylitis is back pain, often associated with stiffness, especially in the morning or after periods of rest. The pain is usually located in the lower back and buttocks, and the stiffness can make everyday movements more difficult. These symptoms can last longer and become more intense as the disease progresses.
Inflammation of peripheral joints
In addition to affecting the spine, ankylosing spondylitis can cause inflammation of peripheral joints, such as those in the hips, knees, ankles, elbows, and shoulders. This inflammation can lead to pain, swelling, and limited movement in these joints, and symptoms can range from moderate to severe. In some cases, joints can become permanently stiff or deformed.
Fatigue and decreased mobility
Chronic fatigue is another common symptom in people with ankylosing spondylitis. The ongoing inflammation can deplete the body's energy resources, leading to a constant feeling of fatigue and difficulty concentrating. Also, as the disease progresses, the mobility of the spine and other joints can be severely affected, leading to decreased flexibility and the ability to perform regular physical activities.
How is ankylosing spondylitis diagnosed?
The diagnosis of ankylosing spondylitis is made through a combination of clinical evaluation, imaging studies, and laboratory tests. Given that symptoms can be subtle and develop gradually, it is important that the diagnosis is established early to prevent disease progression and to implement appropriate treatments.
Clinical examination and medical history
The first step in diagnosing ankylosing spondylitis is to evaluate the patient's symptoms and medical history. The doctor will examine the patient for signs of inflammation in the spine and peripheral joints, check mobility, and ask about chronic low back pain, morning stiffness, and their duration. Family history can also be an important clue, given that ankylosing spondylitis has a genetic component, and its presence in a family can increase the risk of developing the disease.
Magnetic resonance imaging (MRI) and x-rays
Magnetic resonance imaging (MRI) and x-rays are essential for visualizing lesions in the spine and sacroiliac joints. MRI can detect signs of inflammation or early lesions that are not visible on x-rays. X-rays can also show signs of vertebral fusion, which is characteristic of advanced stages of the disease.
HLA-B27 Test
The HLA-B27 test is a laboratory test used to detect the presence of the HLA-B27 gene, a genetic factor associated with an increased risk of developing ankylosing spondylitis. Nearly 90% of people with the condition carry the HLA-B27 gene.
Treatment of ankylosing spondylitis
Treatment of ankylosing spondylitis aims to reduce inflammation, relieve pain, and improve mobility, in order to prevent or slow the progression of the disease. This involves a combination of medications, physical therapy, and lifestyle changes.
Anti-inflammatory treatments
Anti-inflammatory treatments for ankylosing spondylitis include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, which help reduce inflammation and pain, and in more severe cases, biologic drugs, such as TNF-alpha inhibitors (e.g. adalimumab, infliximab) and IL-17 inhibitors (e.g. secukinumab), are used to target specific inflammatory processes and prevent joint damage.
Non-steroidal and biologic drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or diclofenac, are commonly used to reduce pain and inflammation associated with ankylosing spondylitis. They are effective in controlling mild to moderate symptoms, helping to reduce inflammation and improve joint stiffness.
Physiotherapy and rehabilitation exercises
Physiotherapy plays an essential role in the treatment of ankylosing spondylitis. Regular physical exercise can help maintain spinal flexibility and improve mobility of affected joints. The physiotherapy program is personalized according to the patient's needs and may include stretching exercises, muscle strengthening, and breathing techniques to reduce stiffness and pain. Also, correct posture and avoiding long periods of inactivity are recommended to prevent joint damage and improve the patient's quality of life.
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Personalized Integrative Therapy
Personalized integrative therapy combines conventional treatments with alternative approaches to support patients’ health and recovery. In the case of ankylosing spondylitis, this therapy may include a mix of medications, physiotherapy, lifestyle changes and stress management techniques, tailored to the individual needs of the patient. Some examples of approaches are
1. HHO® Therapy (Hemoperfusion, Hyperthermia and Oxygenation), which includes three distinct stages to support the healing process:
Hemoperfusion: This first phase involves purifying the patient’s blood through a special filter that removes toxins and harmful substances, while the blood is warmed and enriched with oxygen. This helps improve blood quality and detoxification.
Hyperthermia: The second stage consists of a controlled increase in body temperature, a process also known as therapeutic fever. This increase in temperature stimulates the immune system and facilitates the healing and regeneration processes of inflamed tissues.
Oxygenation: The final stage involves providing an additional flow of oxygen to the blood, which is now cleaned and enriched. Oxygenation contributes to improving cellular function and has beneficial effects on the immune system and the body's regeneration processes.
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2. Ozone therapy
Ozone therapy is an alternative method that uses medical ozone to stimulate the body's natural healing processes. This therapy has antioxidant, antibacterial and anti-inflammatory effects, contributing to tissue oxygenation, improved circulation and the elimination of toxins. In the case of ankylosing spondylitis, ozone therapy can reduce pain, inflammation and joint stiffness, supporting cell regeneration and optimal immune system function.
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3. PAPIMI Therapy
PAPIMI Therapy uses high-intensity magnetic pulses to stimulate cell regeneration and improve the metabolism of affected tissues. This innovative technology helps reduce inflammation, relieve pain and accelerate the tissue healing process. In ankylosing spondylitis, PAPIMI Therapy can help improve joint mobility and reduce chronic symptoms.
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4. Intravenous Curcumin Infusions
Curcumin, the active compound in turmeric, is known for its anti-inflammatory and antioxidant properties. Administered intravenously, it helps reduce systemic inflammation, combat oxidative stress, and protect tissues from damage. In ankylosing spondylitis, curcumin can improve inflammatory symptoms, helping to reduce pain and improve patients' quality of life.
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5. Intravenous Infusions with Resveratrol
Resveratrol is a powerful antioxidant found in the skin of red grapes, with beneficial effects on the cardiovascular and immune systems. Administered intravenously, resveratrol helps combat inflammation, protects cells against oxidative stress, and supports tissue regeneration. This therapy may be useful in controlling chronic inflammation associated with ankylosing spondylitis.
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6. Boswellia Intravenous Infusions
Boswellia, an extract from the Boswellia serrata tree, is recognized for its natural anti-inflammatory properties. Administered intravenously, it reduces inflammation in joints and tissues, supporting joint function and reducing symptoms such as pain and stiffness. In ankylosing spondylitis, Boswellia infusions are an effective alternative for reducing the inflammatory process and improving mobility.
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Recommended lifestyle for spondylitis
Adopting a healthy and balanced lifestyle is essential for managing ankylosing spondylitis. In addition to medical treatments, a proper diet and regular exercise routine can help reduce inflammation, improve mobility, and reduce the risk of complications.
Anti-inflammatory diet
An anti-inflammatory diet is recommended for people with ankylosing spondylitis, as it can help reduce inflammation in the body and manage symptoms. This should be rich in anti-inflammatory foods, such as fatty fish (salmon, sardines), nuts, seeds, green leafy vegetables, and berries. Foods rich in omega-3 fatty acids, antioxidants, and fiber can help reduce inflammation. It is also important to avoid processed foods, refined sugars, and fats, which can worsen inflammation.
The importance of a regular physical routine
Regular physical exercise is essential for maintaining joint mobility and preventing stiffness associated with ankylosing spondylitis. Activities such as walking, swimming, and yoga can help strengthen muscles, improve flexibility, and reduce pain. A regular exercise program can also help maintain good posture and prevent loss of mobility in the spine.
Conclusion
Ankylosing spondylitis is a chronic condition that requires a comprehensive treatment approach that includes medication, physiotherapy, and lifestyle changes. An anti-inflammatory diet and a regular exercise program can play an important role in managing symptoms and improving patients' quality of life. With appropriate treatment and a healthy lifestyle, people with ankylosing spondylitis can live active and fulfilling lives, effectively managing the disease over the long term.
Bibliographical sources
Sieper, J., Braun, J., Rudwaleit, M., Boonen, A., & Zink, A. (2002). Ankylosing spondylitis: an overview. Annals of the rheumatic diseases, 61(suppl 3), iii8-iii18.
Online Articles
https://www.doc.ro/poliartrita-reumatoida-analize-simptome-tratament/spondilita-anchilozanta-simptome-cauze-si-tratament - Accessed on 06.12.2024
https://www.mayoclinic.org /diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808 -- Accessed on
06.12.2024
https://www.nhs.uk/conditions/ankylosing-spondylitis/ -- Accessed on 06.12.2024
