Ankylosing Spondylitis treatment by Ray Sahelian, M.D. Ankylosing Spondylitis symptom

Ankylosing spondylitis is an inflammatory chronic disease that affects young males and in more than 90% of cases is associated with HLA B27 antigen. Therapeutic options for patients with this condition has been limited. Infliximab and etanercept are both approved for the treatment of patients with active disease that does not respond to conventional therapies. Anti-TNF therapy is effective in ankylosing spondylitis and dietary options should also be explored.
   Some claim that Klebsiella pneumoniae is the main microbial agent being implicated as a triggering and/or perpetuating factor in the cause of ankylosing spondylitis.

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Natural options for ankylosing spondylitis diet and supplements
It is possible that diet and certain supplements could be helpful in reducing symptoms of ankylosing spondylitis. Consuming an anti-inflammatory diet mostly made composed of vegetables and fish could be helpful, and perhaps Fish-Oil supplements could also ease symptoms of this condition.

Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis.
Scand J Rheumatol. 2006 Sep-Oct;35(5):359-62. Sundstrom B, Stalnacke K, Hagfors L, Johansson G. Department of Medical Rehabilitation, Gallivare Hospital.
To study the effect of supplementation with omega-3 fatty acids on disease variables and drug consumption in patients with ankylosing spondylitis. Twenty-four patients were randomized to either a low-dose (1.95 g omega-3/day) or a high-dose (4.55 g omega-3/day) supplement. Disease activity, functional impairment, erythrocyte sedimentation rate (ESR), and drug consumption were assessed during visits at baseline and at weeks 7, 14, and 21.Results: Eighteen patients completed the study, nine patients from each group. The patients in the high-dose group exhibited a significant decrease in disease activity according to the Bath Ankylosing Disease Activity Index, which was not seen in the low-dose group. Significant differences were not found on drug consumption or in functional capacity in either of the groups. No significant differences were found when comparing the results between the high- and low-dose groups. Conclusion: Omega-3 fatty acids in adequate doses may have the capacity to decrease the disease activity of ankylosing spondylitis. However, larger and better controlled studies are needed before any further conclusions can be made on the extent of this capacity.

Diet influences Ankylosing Spondylitis
Results from a clinical study of patients living north of the polar circle in Sweden and suffering from ankylosing spondylitis showed that treatment with fish oils provides some improvement in blood inflammatory factors. Ankylosing spondylitis is a chronic disease mainly affecting joints of the spine and often the larger joints of the extremities. It is more common in males than females. To study the effect of supplementation with fish oils on disease variables in patients with ankylosing spondylitis, patients were randomized to either a low-dose (2 g a day) or a high-dose (4.5 g a day) fish oil supplement. The patients in the high-dose group exhibited a significant decrease in disease activity which was not seen in the low-dose group. Significant differences were not found on drug consumption or in functional capacity in either of the groups. The researchers conclude that fish oils in adequate doses may have the capacity to decrease the disease activity of ankylosing spondylitis.
   Comments: It is possible that adopting an anti-inflammatory diet with high fish and vegetable consumption, along with taking fish oils, may provide further benefit to those with this condition.

Ankylosing spondylitis medication
Non steroidal antiinflammatory drugs (NSAID) used to be the only drugs active in ankylosing spondylarthritis. However, they are inadequate or ill-tolerated in many patients, and have no proven impact on disease-related structural changes. Clinical trials have shown two anti-TNF alpha agents - infliximab and etanercept - could be helpful in patients with NSAID-resistant ankylosing spondylitis. These drugs ease inflammatory pain, stiffness and functional disability, and improve mobility and quality of life. Tolerability is satisfactory, and efficacy persists during several years of treatment. There is not enough evidence to support any benefit of methotrexate in the treatment of ankylosing spondylitis.

Infliximab for ankylosing spondylitis
Treatment with Infliximab in a patient with ankylosing spondylitis and Crohn's disease.
J Gastrointestin Liver Dis. 2006 Dec;15(4):379-82. Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Str. Clinicilor 2-4, 400006 Cluj-Napoca, Romania;
The association of Crohn's disease and ankylosing spondylitis is described in up to 30% of cases. We present the case of a 53 year old woman, diagnosed with colonic Crohn's disease and ankylosing spondilitis, treated initially with increasing doses of sulphasalazine and moderate dose of corticosteroids, with the persistence of severe gastrointestinal and articular symptoms. She underwent therapy with tumor necrosis factor alpha (TNFalpha) inhibitor Infliximab, with a spectacular improvement of symptoms, signs and quality of life.

Etanercept for ankylosing spondylitis - side effect
Adverse effect of TNF-alpha blocker etanercept - Demyelination in an ankylosing spondylitis patient: a case report.
J Clin Pharm Ther. 2006 Dec;31(6):645-8. PM&R and Rheumatology Department, Medical Faculty, Akdeniz University, Antalya, Turkey.
Anti-tumour necrosis factor (TNF)-alpha agents promise better disease control for treatment of inflammatory arthritides which are resistant to classical disease-modifying treatment and provide better functional outcome. But these agents are not free of adverse events. The exact relationship between use of anti-TNF drugs and development of demyelination cannot be established yet. Here we present a case of a 36-year-old man who developed demyelination in the cervical spinal cord while he was being treated with etanercept for ankylosing spondylitis.

Ankylosing spondylitis questions
Q. I am a medical doctor and have a question in relation to the condition Ankylosing Spondylitis, would you know of any herbal or ayurvedic remedy for this condition. If you ever travel to south Asia (Sri Lanka and/or India) I would very much like to meet with you. You are always welcome here in Colombo, Sri Lanka which a long history of herbal medicine.
   A. Thank you for the invitation. It appears anti-inflammatory approach is a good option and we will update this page as more info is published. Fish oils and eating more fish and vegetables should be tried.