Putting Ankylosing Spondylitis in Its Place: Remission
What Is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is a type of arthritis, an inflammatory disease that causes pain, stiffness, and swelling in the joints. AS most often affects the joints of the spine, which are more commonly known as vertebrae. Pain in the hips and shoulders is also common in people who have AS. Like other forms of arthritis, ankylosing spondylitis does not have a cure. However, treatment can manage symptoms, and may even put you into remission.
Symptoms of AS
Symptoms of AS are much like other signs of arthritis:
- joint stiffness, especially upon waking
- tenderness around the joints
- pain with physical activity
- visible inflammation of the joints
AS inflammation can also affect your eyes, heart, or lungs. However, these symptoms are less common. Severe spondylitis can cause portions of your spine to become fused together. The inflammation in your spine causes new bone growth, which binds to the existing vertebrae. This fusion process may lead to kyphosis, an abnormal rounding of the upper part of the spine.
Treatment goals for ankylosing spondylitis include relieving your pain, helping your joints move more smoothly, and preventing deformity of the spine. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce both pain and inflammation. People with mild symptoms might find over-the-counter NSAIDs to be effective, while those with moderate or severe symptoms may require prescription-strength medications. Your doctor might also recommend physical therapy or a regular exercise routine to maintain flexibility.
Remission is also a treatment goal. Most people with AS make a protein called HLA-B27 that causes inflammation. To go into remission from AS, you’ll need to get your body to stop responding to this protein.
What Is Remission?
According to a 2006 issue of Clinical and Experimental Rheumatology, the technical definition of remission is “a state of persistent absence of clinical and radiologic signs of disease activity without treatment for a specific time period.” In other words, symptoms of the disease disappear for a period of time without having any treatments. Remission of AS in particular is defined as a “low level disease activity,” with little inflammation and physical limitation caused by joint stiffness and pain. TNF-blocking drugs, which are described on the next slide, can help put people with AS into remission.
TNF stands for “tumor necrosis factor.” This term refers to a protein that causes inflammation in people who have rheumatoid arthritis and other autoimmune diseases. TNF blockers are medications that block the inflammation-causing proteins from causing symptoms. TNF-blocking drugs are referred to as biologics because they change the way your body works. When your immune system is put off the path of creating inflammation, your pain and joint stiffness subsides, and you may go into remission. The Journal of Rheumatology published research in 2012 with promising results. Approximately 35 percent of patients studied went into remission after following a carefully monitored drug regimen that included TNF inhibitors.
Medication can help you achieve remission in some cases, but you may not know what to do while you’re waiting for your symptoms to recede. Eating healthy and maintaining an appropriate weight is a good start. Your joints are only equipped to handle a certain amount of weight. When you overload your joints with extra weight—especially your back, hips, and knees—they aren’t able to function as efficiently. If you have AS or another form of arthritis, your joints are already damaged. Without proper self-care, your symptoms can become worse.
Whole grains, fresh fruits and vegetables, low-fat dairy products, and lean proteins are all part of a healthy diet. Managing inflammation and autoimmune conditions, however, can be tricky when it comes to dietary choices. You might start to notice a pattern of increased symptoms after eating certain foods. If this is the case, speak to your doctor about starting an elimination diet to figure out which foods seem to affect your joints.
Low Starch Diet
A low-starch diet may help put some AS patients into remission. London rheumatologist Dr. Alan Ebringer found in the 1990s that some AS patients had higher-than-normal levels of IgA, an antibody that fights infection. The same patients also had bacteria in their digestive system that seemed to be intensifying their arthritis symptoms. The bacteria, called Klebsiella, feeds off starch. By reducing the amount of starch you eat, the bacteria can’t flourish, and AS symptoms may diminish as well. Those who follow a no-starch diet are advised to cut back on rice, potatoes, pasta, and bread. It is suggested that you instead fill your meals with meats, non-starchy vegetables, dairy, and eggs. Check with your doctor before changing your diet.
While remission is possible with ankylosing spondylitis, the 35 percent remission rate quoted in The Journal of Rheumatology is still a fairly low number. Daily management of the disease is a realistic way to treat AS while striving for the clinical “absence of… disease activity.” Medications, exercise, proper posture, and a healthy diet can help you live a life that can be as independent and pain-free as possible.
- About Ankylosing Spondylitis. (2012). Spondylitis Association of America. Retrieved September 3, 2013, from http://www.spondylitis.org/about/as.aspx
- Ankylosing spondylitis: Treatments and drugs. (2011, February 3). Mayo Clinic. Retrieved September 3, 2013, from http://www.mayoclinic.com/health/ankylosing-spondylitis/DS00483/DSECTION=treatments%2Dand%2Ddrugs
- Diet and AS | Managing My AS. (2012). National Ankylosing Spondylitis Society | . Retrieved September 3, 2013, from http://nass.co.uk/about-as/managing-my-as/diet-and-as/
- Ebringer, A. & Wilson, C. (1996, January). The use of a low starch diet in the treatment of patients suffering from ankylosing spondylitis. Clin Rheumatol., 15(Suppl. 1), 62-66. Retrieved September 3, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/8835506
- Kyphosis: Definition. (2012, June 14). Mayo Clinic. Retrieved September 12, 2013, from http://www.mayoclinic.com/health/kyphosis/DS00681
- Low Starch/London AS Diet. (2012). Spondylitis Association of America. Retrieved September 3, 2013, from http://www.spondylitis.org/about/diet_lowstarch.aspx
- Paccou, J. et al. (2012, June 15). Dosage Adjustment of Anti-Tumor Necrosis Factor-α Inhibitor in Ankylosing Spondylitis Is Effective in Maintaining Remission in Clinical Practice. (2012). The Journal of Rheumatology. doi:10.3899/jrheum.111337. Retrieved September 3, 2013, from http://jrheum.org/content/early/2012/06/11/jrheum.111337.abstract
- Zochling, J. & Braun, J. (2006). Remission in ankylosing spondylitis. Clinical and Experimental Rheumatology, 24(Suppl. 43), S88-S92. Retrieved September 3, 2013, from http://www.clinexprheumatol.org/article.asp?a=2945