What is ankylosing spondylitis?

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 other forms of arthritis, AS doesn’t have a cure. However, treatment can manage symptoms and may even put AS into remission.

Symptoms of AS are much like other signs of arthritis:

  • joint stiffness, especially upon waking
  • tenderness around your joints
  • pain with physical activity
  • visible inflammation of your joints

AS inflammation can also affect your eyes, heart, or lungs. However, these symptoms are less common. Severe AS 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, and preventing deformity of your 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. To go into remission from AS, the inflammatory response it causes must be dampened and controlled with medications.

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 ongoing treatments. Remission of AS in particular is defined by a low level of disease activity, with little inflammation and physical limitation caused by joint stiffness and pain.

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 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.

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 equipped to handle only 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. Limiting processed foods and sugar is also important. 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.

A low-starch diet may help put some AS patients into remission. In the 1990s, London rheumatologist Dr. Alan Ebringer found that some people with AS had higher-than-normal levels of IgA, an antibody that fights infection. 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 you eat, the bacteria can’t flourish, and AS symptoms may diminish as well.

To follow a low-starch diet, you need to cut back on rice, potatoes, pasta, and bread. Instead, you would fill your meals with meats, nonstarchy vegetables, dairy, and eggs.

Check with your doctor before changing your diet.

While remission is possible with AS, 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 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.