Ankylosing spondylitis (AS) is a type of arthritis, an inflammatory disease that causes pain, stiffness, and swelling in the spine as well as some weight-bearing peripheral joints.
AS most often affects the joints of the spine, which are commonly known as vertebrae. Pain in the hips, knees, and shoulders is also common in people who have AS.
Like many other forms of arthritis, AS doesn’t have a cure. However, treatment can help manage symptoms and may even put AS into remission.
Remission in AS is defined by a low level of disease activity, with joint stiffness and pain causing little inflammation and physical limitation.
Your doctor may use the following tools to help determine your disease activity:
- a physical examination of your joints
- a questionnaire about your pain and mobility
- blood tests to measure certain markers of inflammation
- magnetic resonance imaging (MRI)
Certain markers are used to determine clinical remission.
For instance, a
More research needs to be done to fully understand remission in AS.
Medical professionals have not conclusively determined the degree of progression or how long a person needs to have low disease activity to be considering in remission.
Symptoms of AS are much like other signs of arthritis:
- dull back pain, sometimes on varying sides
- joint stiffness, especially upon waking
- some relief as the days goes on, or from light exercise and stretching
AS inflammation can also affect your eyes, heart, stomach, or lungs. However, these symptoms are less common and more typical in later stages.
Severe AS left untreated 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 your spine.
Treatment goals for AS include:
- relieving your pain
- helping your joints move more smoothly
- preventing increased inflammation and spreading to other parts of the body
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce both pain and inflammation.
People with mild symptoms might find over-the-counter NSAIDs to be an effective treatment while those with moderate or severe symptoms may require prescription-strength medications to treat their AS.
Your doctor will likely also recommend physical therapy or a regular exercise and stretching routine to help maintain flexibility. Swimming is excellent if you have access to a heated pool.
Remission is also a treatment goal. To go into remission from AS, the inflammatory response it causes must be slowed and managed with medications.
TNF stands for tumor necrosis factor. This term refers to a protein that immune cells make that causes inflammation in people who have rheumatoid arthritis and other autoimmune diseases.
TNF blockers, or inhibitors, are medications that block inflammation-causing proteins in order to prevent symptoms. TNF-blocking drugs are referred to as biologics because they mimic how your body normally 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 participants went into AS remission after following a carefully monitored drug regimen that included TNF inhibitors.
A different 2019 study suggested that one-third of people living with AS included in the study needed no anti-rheumatic treatment after 5 years after treatment with TNJ inhibitors.
It’s possible that people with AS may need to try multiple types of treatments to find one that helps them on the path to remission.
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.
Excess weight can apply pressure to already damaged joints, while having too little body fat may lead to conditions such as chronic fatigue and anemia, and added inflammation.
Eating foods that promote good health and achieving and maintaining a healthy weight may help with discomfort.
The Spondylitis Association of America recommends the following:
- including enough calcium and vitamin D in your diet to support strong bones, and use a supplement if your doctor recommends it
- consuming less than two alcoholic drinks per day to help avoid affecting bone density negatively
- eating foods rich in antioxidants, such as bright-colored fruits and vegetables as much as possible
- eating foods rich in omega 3 fatty acids, such as salmon and flax seeds, as often as possible
- try to focus on cooking with healthy fats and avoiding excess cholesterol, sugar, and salt
- try to limit foods high in artificial ingredients and preservatives
- stay well hydrated
- talk with your doctor about screening for low levels of vitamins, minerals, and supplement as recommended
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 with your doctor about starting an elimination diet to figure out which foods seem to affect your joints most.
There’s some evidence that a low-starch diet may help put AS in remission in some people.
In the 1990s, London rheumatologist
The same people also had bacteria in their digestive system that seemed to be intensifying their arthritis symptoms. The bacteria, Klebsiella, feeds off starch.
By reducing the amount of starch eaten, the bacteria can’t flourish, and AS symptoms may diminish as well.
Speak with your doctor to see if you should consider limiting starches in your diet. Removing or limiting certain foods can have negative effects on your health, so keep your doctor informed of your eating choices.
While remission is possible with AS, many people are still searching for a way to find lasting relief for their symptoms.
Daily management of the disease is a realistic way to treat AS while striving for absence or significant reduction 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.