Ankylosing Spondylitis
Ankylosing Spondylitis
Ankylosing Spondylitis (AS) is a chronic inflammatory condition that predominantly affects the spine, causing stiffness and pain. Over time, the pain typically progresses from the lower back to the upperback. Severe cases may result in the fusion of the spinal joints, leading to significant stiffness. Other areas, such as the hips, chest wall, and heels, can also be affected. In children, symptoms usually start in the hips, knees, heels, or big toes and later progress to the spine
Genetic Risk Factors
Genetic factors, including the presence of ERAP1, ERAP2, and interleukin-23R, are known to increase the risk of developing AS. Another critical factor is the presence of the HLA-B27 marker, although its presence does not guarantee the development of AS.
The Role of Microbiome
An exciting area of research has revealed a connection between the gut microbiome and AS. The gut microbiome, comprising trillions of microorganisms, has been linked to various health conditions, including AS and Crohn’s disease. Specifically, the bacterium Klebsiella has been shown to trigger AS and Crohn’s disease due to cross-reactivity in HLA-B27 genetically susceptible patients.
Associated Conditions
AS may also come with other conditions such as uveitis (inflammation of the eye) and vasculitis (inflammation of the blood vessels).
Assessment
A key part of managing AS is regular assessment. The Schoeber’s test is one method used to assess the restriction in lumbar flexion. While the patient is standing, the examiner marks two points on the back: 5 cm below and 10 cm above the level of the fifth lumbar vertebra. The patient is then asked to touch their toes while keeping their knees straight. If the distance between the two points does not increase by at least 5 cm (total distance greater than 20 cm), it indicates a restriction in lumbar flexion.
Managing Ankylosing Spondylitis
Managing AS will require a good multidisciplinary approach.
- Rheumatologist: I have good relationships with world-class rheumatologists who can evaluate whether you need TNF therapy.
- Functional Medicine: Similarly, if the gut microbiome requires significant attention beyond my nutritional therapy skills, functional medicine can more thoroughly assess gut function and tailor an approach.
I can provide:
- a. Education: Using my 5 pillars
- Understanding your pain, its causes, how you can modify it and understanding the rehabilitation process.
- Understanding ergonomics at work and home, and optimising rest and recovery.
- Understanding nutrition, hydration, and supplementation.
- Understanding the influence of psychology & stress management.
- Understanding technology accelerators, biohacking, and the environment.
- b. Hands-On Treatment: To improve range of motion and provide relief as needed.
- c. Home Exercise Programme: To normalise range of motion, improve strength and endurance as part of gradually returning to all your normal activities.
- a. Education: Using my 5 pillars
Case Study
ES came to see me with 3 months of pain in the left sacroiliac joint. She is HLA-B27 positive and was diagnosed with ankylosing spondylitis. ES’s rheumatologist decided she didn’t need to start anti-TNF. ES had clear signs of dysbiosis- too many “bad” bacteria in the gut and altered bowel movements. We started with education on the 5 pillars, and as part of this, ES followed a highly specialised diet to starve the Klebsiella bacteria and improve the gut microbiome. In addition, she did her home exercise program, and I provided some manual therapy for pain relief. After 5 weeks, her pain had subsided.
AS is a complicated chronic condition and I explained that it was highly likely her symptoms may return but by understanding the 5 Pillars as they relate to AS she has a good chance of controlling the controllable variables.
Conclusion
Ankylosing Spondylitis is a complex condition influenced by genetic, microbiome, and environmental factors. Managing it requires a multidisciplinary approach involving rheumatologists, functional medicine, and personalised treatment plans encompassing education, hands-on treatment, and a home exercise program. Regular assessment and monitoring are crucial for managing the condition effectively.
If you suspect you have AS, consult a healthcare professional for a comprehensive assessment and personalised management plan.
