ANKYLOSING SPONDYLITIS

A QUALIFIED AYURVEDA PRACTITIONER SHOULD BE CONSULTED TO ENSURE APPROPRIATE PROCEDURES AND MONITOR PROGRESS

The term "Ankylosing Spondylitis (ANKYLO" mean stiffening and "Spondylitis" means inflammation in the vertebral joints) is an auto-immune (Our own immune system attacking the body) chronic inflammatory condition (Inflammation is a condition which arises as a result of the body's reaction to external trauma or an infection which is usually characterized by redness, swelling, pain and rise in temperature) of the part of the vertebral joint called the enthesis. The inflammation in turn leads to the stiffening of the affected part which may in turn lead to stiffness and low back pain, neck and gradually the entire vertebral column and leads to a hunched back posture.

WHAT IS ANKYLOSING SPONDYLITIS

Ankylosing spondylitis (AS) is a chronic inflammatory disease causing axial arthritis, frequently resulting in inflammatory low back pain early in the disease course, with eventual severe impairment of spinal mobility due to structural changes ultimately leading to spinal fusion. In addition to axial arthritis, AS can result in peripheral arthritis, enthesitis, and uveitis, all shared characteristics of the SpA. Inflammation often spreads to joints between the vertebrae, the bones that make up the spinal column. This condition is known as spondylitis. Some people with AS experience severe, persistent back and hip pain and stiffness. Others have milder symptoms that come and go. Over time, new bone formations may fuse vertebrae sections together, making the spine rigid. This condition is called ankylosis.

TYPES OF ANKYLOSING SPONDYLITIS

Ankylosing spondylitis - the most common type. It usually affects the spine, lower back, and hip joints.
Enteropathic arthritis (EnA) - This type of spondylitis is characterized by pain and inflammation in the intestines. You may have back and joint pain.
Psoriatic arthritis (PsA) - This type of spondylitis causes back pain and stiffness. It's associated with psoriasis of the skin. Psoriatic arthritis mostly causes pain and swelling in smaller joints, like in the fingers and toes.
Reactive arthritis/Reiter's syndrome (ReA) - ReA is a type of spondylitis that usually occurs after a bacterial infection. It could be due to a sexually transmitted infection, such as chlamydia, or a gastrointestinal infection from food contaminated with Salmonella.
Juvenile spondylitis (JSpA) - JSpA is a type of arthritis that occurs in children and teenagers. This kind of arthritis usually affects the leg joints. One leg may be affected more than another.
Undifferentiated spondylitis - This type of spondylitis is called undifferentiated because it doesn't meet the criteria for a diagnosis of ankylosing spondylitis or related disease.

CAUSES OF ANKYLOSING SPONDYLITIS

Cervical spondylosis is a disease which affects inter vertebral discs of cervical vertebrae. For understanding the pathology, cervical spine anatomy should be understood. Cervical spine contain 7 vertebrae. A spongy gel like substance is situated between two vertebrae called intervertebral disc (IV Disc) which provide a cushioning effect .Cervical nerves are emerging out from pathways corresponding to spine. In cervical spondylosis, these IV discs and vertebrae are affected in different manner.
Causes can be summarized as below
Dehydrated discs: In this condition discs may loss its spongy nature and become dry results in direct bone to bone contact which cause pain.
Intervetebral disc prolapse: Sometime IV discs may slip from vertebral space causing compression to nerve roots resulting in pain, numbness and disabilities.
Bone spurs: Degeneration of vertebrae sometime results in abnormal growth of bony structure called as spur. This may come in contact with nerve root or spine.
The exact causes of Ankylosing Spondylitis are not known.
However it is understood that the vulnerability to the disease is usually is inherited by virtue of the genes.
Persons who are positive for HLAB27 are particularly at risk.
Other environmental trigger are also known to trigger the condition. Not everyone with a positive HLAB27 develops the disease.
Ayurveda describes, excessive exertion, ingestion of spicy and incompatible foods, stress, lack of adequate, rest and leading a very sedentary life, as factors responsible for triggering the condition.

SYMPTOMS OF ANKYLOSING SPONDYLITIS

Pain and stiffness (especially the neck) are the primary symptoms one might experience. Pain may be seen in the regions of low back, hip joint and may last for a period of more than 3 months usually.
Bony fusion is another sign in this condition where the vertebrae fuse together leading to a hunched back posture.
It can also affect the neck leading to inability to turn the neck.
It is also associated with other systemic symptoms like Iritis (Inflammation, redness in the eyes), Fever, Fatigue and Loss of appetite.
In some rare cases it may also be associated with heart and lung diseases.
In chronic cases it leads to restriction in the ability to breathe freely.
Pain over the cervical region usually increased by excess movement and strain
Referred pain: pain may transfer to the back of head, shoulders and upper arms
Numbness, tingling, or weakness in upper limbs
Feel of giddiness on the sudden movement of the head

WHO ARE MORE SUSCEPTIBLE?

People with a sedentary lifestyle
Aged persons
IT professionals or people who are using computers and typing instruments for a prolonged time.
People with previous injuries to the neck
People lifting heavy weights regularly
People maintaining poor postures during sleeping or sitting.
People with digestive disorders.
People with the heredity of Arthritis.
People with hormonal disorders like hypo/ hyper- thyroidism, PCOS, auto immune diseases.

NON MEDICINAL MANAGEMENTS INCLUDE

Immobilization of neck with help of collars or any other measures to reduce acute pain
Isometric cervical exercises will help to retain muscular tone
Mechanical tractions are widely used technique for treating spondylosis.
Occupational therapies to improve quality of life.
Lifestyle modifications may involve an evaluation of workplace ergonomics, postural training, neck-school ,stress management etc
If condition not improving with all these measures surgical interventions may be needed.
Physiotherapy and leading an active lifestyle are recommended. Swimming is very helpful to keep the muscle strong and to keep the lungs functional.
Physiotherapy and leading an active lifestyle are recommended. Swimming is very helpful to keep the muscle strong and to keep the lungs functional.

YOGA

Simple techniques like moving neck to the front, back and sidewise, rotating shoulders in both clockwise and anticlockwise directions may help to reduce neck pain.
Yoagasanas like bhujangasana, matsyasana, etc can be practiced with the help of a yoga trainer.

DAIGNOSIS

There isn't a test that definitively diagnoses ankylosing spondylitis. After reviewing your symptoms and family history, your healthcare provider will perform a physical exam. Your provider may order one or more of these tests to help guide diagnosis:

Imaging scans: Magnetic resonance imaging (MRI) scans can detect spine problems earlier than traditional X-rays. Still, your provider may order spine X-rays to check for arthritis or rule out other problems.
Blood tests: Blood tests can check for the presence of the HLA-B27 (human leukocyte antigen-B ) gene.

COMPLICATION ANKYLOSING SPONDYLITIS

Ankylosing spondylitis may affect more than the spine. The disease may inflame joints in the pelvis, shoulders, hips and knees, and between the spine and ribs. People with AS are more prone to spinal fractures (broken vertebrae). Other complications include:

Fused vertebrae (ankylosis).
Kyphosis (forward curvature of the spine).
Osteoporosis.
Painful eye inflammation (iritis or uveitis) and sensitivity to light (photophobia).
Heart disease, including aortitis, arrhythmia and cardiomyopathy.
Chest pain that affects breathing.
Jaw inflammation.
Cauda equina syndrome (nerve scarring and inflammation).

TREATMENT FOR ANKYLOSING SPONDYLITIS

(I) PANCHAKARMA THERAPY:

For increasing the Agni, excretion of Aama (toxin or undigested metabolic waste) and removal of vitiated and accumulated Doshas, purification or Shodhana and pacifying or Shamana treatments are given. This category of treatment comes under Panchkarma therapy. It consists of

Medicated or retention enemas.
Medical emesis.
Medical purgation
Nasal medication.
Bloodletting.

Out of these five treatments the medicated enema is considered to be the most effective and specific therapy for this category of diseases. Emesis and purgation may reduce Agni and hence are not much used in this treatment. Bloodletting is effective but because of its invasive nature is not used. Medicated or retention enemas include herbal retention enemas and oil retention enemas.

(II) AYURVEDIC TREATMENT FOR ANKYLOSING SPONDYLITIS:

Ayurveda has a very effective approach to the treatment of inflammations even those of auto-immune nature. The approach is holistic comprising of diet modifications, lifestyle changes, stress management, herbal medication and Ayurvedic therapies, Yoga asanas, pranayama and meditation, that help the body get back to Homeostasis (state of balance and harmony). The approach is even effective as a preventive against further relapses of the condition.

In usual practise, we observe that many patients improve very well with herbal medicines and external applications alone but some with severe symptoms require therapies like Dhanymladhara (Pouring of a warm fermented liquid), Podikkizhi (Herbal powder massage) Ilakkizhi (Massage with bolus of fresh herbal leaves), Oil massage with steam bath and several varieties of Vasthi (Medicated enema). These therapies if administered under the supervision of knowledgeable Ayurvedic physicians are all very effective in relieving the inflammation and keeping the problem away without the need for powerful drugs. Therapies like Tailadhara (Pouring medicated oils on the body), Njavarakkizhi (Massage with Bolus of rice boiled in medicated milk) and Ksheervasthi (Medicated milk based enema) are then used and are extremely effective in strengthening the tissues and improving flexibility.

AYURVEDIC TREATMENT FOR ANKYLOSING SPONDYLITIS AT AYURVEDA RAKSHA

At AYURVEDA RAKSHA, we specialize in the offering individualized treatment of Ankylosing Spondylitis and have had very high success rate at achieving and maintaining remission and good functionality in patients suffering from Ankylosing Spondylitis without the need for steroids, disease modifying drugs or TNF alpha blockers. Our day care centres offer consultation, medication and therapies which are adequate for a large number of patients but some patients with severely active disease and those whose symptoms are chronic may require In-patient therapy in a hospital. Follow-up treatment is possible at our centre's and even at remote locations by continuation of medication and we offer telephone consultation as well.

GUGGULU (COMMIPHORA MUKUL):

This is a well-known drug in Ayurveda which reduces inflammation, it also possesses anti-arthritic properties. Ayurvedic formulations like Gugguluthiktakam Kashayam, Yograja Guggulu,Trayodasanga Guggulu, Kaisore Guggulu, etc are commonly used in the treatment of cervical spondylosis.

OTHER FORMULATIONS USED FOR ANKYLOSING SPONDYLITIS ARE:-

Rasnasaptakam Kashayam
Ashtavargam Kashayam
Prasarinyadi kashayam
Dashamoola Rasnadi kashayam
Dhanadanayanadi kashayam
Aswagandha choornam
Balarishtam
Dhanwanthararishtam
Aswagandharishtam
Prasarinyadi thailam
Karpasasthyadi thailam
Prabhanjanam kuzhambu

(III) HERBS USED TO TREAT SPONDYLITIS ARE

Ayurvedic practice often involves the use of herbs and supplements as treatment.

Use a powdered preparation of dried ginger root, celery seeds and cumin seeds in equal quantities with rock salt for taste, and have one teaspoon of this mixture with warm water at bedtime to reduce flatulence as well as lumbar stiffness.
Dry Ginger
Ashwagandha
Garlic
Guggul, turmeric, fenugreek, and giloy. Gugul, curcumin, amlaki, haritaki are all very effective in treating AS.

An Ayurvedic practitioner may also prepare special oils that contain herbs. People can massage these oils into areas where they experience symptoms.

DIET & LIFESTYLE - FOODS TO EAT

Ayurveda recommends a diet that balances vata. Diet includes light food with proper nutrition.

Examples of foods to eat on this diet include:

Grains that are easy to digest, like cooked oats, rice, and cream of wheat
Leafy vegetables to keep away from constipation and indigestion.
Legumes, such as lentils, dal, mung beans, miso, and tofu
Milk is good for bone health. (avoid curd)
Ghee helps for avoiding degeneration.
Green, leafy vegetables
Meat soup and fish for muscular tone and maintaining bone density.
Berries
Buttermilk
Wild animal meat
Aged wine in moderate amounts
Warm water medicated with Panchkola (Pippali, Pippalimula, Chavya, Chitraka, Shunthi) in small quantity at a time helps in digestion and disintegration of Aama.
Barley, horse gram, kodo millet and the red variety of rice are recommended. These foods are light and easy to digest. Barley kernels and other products made from barley lower inflammatory markers.
Green leafy vegetables and fruits contain a variety of polyphenols, bioflavonoids, catechins, carotenoids, vitamin C, riboflavin, vitamin E, and low molecular weight compounds. These constituents have antioxidant, fibrinolytic and anti-inflammatory characteristics. Vegetables preferably with bitter taste like bitter melon (Memordica charantia), Neem (Azadirachta indica), Patola or luffa, Gokharu (Tribulus terrestris) are recommended.
Spices like ginger, turmeric and garlic help to add flavor to these dishes and also have antimicrobial, anti-inflammatory and analgesic properties besides their Agni promoting impact.
Wine-old wine, Asava and Arishta.
Meat of Laav Pakshi-Jungle bush quail (Perdicula asiatica) prepared with traditional buttermilk.
Use of Warm water, garlic, dried ginger (Saunth), cumin seeds (Jeera), carom seeds (Ajwain), and Heeng will help to reduce the symptoms and should be encouraged. Their ordinary consumption provides gigantic tenderness liberation to ankylosing spondylitis patients.

AVOID /STOP

Examples of foods to avoid on this diet include:

Avoid Fried foods, processed meats and foods high in fat and sugar can have an inflammatory effect.
The majority of allergens come from dairy and animal products, which cause an increased production of pro-inflammatory prostaglandins.
Cold and impure water
Lentils like Urad and heavy foods.
Sour and fermented foods, like hard cheeses, sour cream, green grapes, pineapple, grapefruit, and alcohol
Heating spices, like chili powder and cayenne pepper (Replace these with warming spices like cinnamon, nutmeg, and turmeric)
Vegetable like arabi or eddo (Colocacia antiquorum) Indian spinach (Basella rubra).
Salt, Fish and sea foods.
Hard-to-digest fruits and vegetables, like raw radishes, turnips, onions, apples, broccoli, and Brussels sprouts
Sour and fermented foods, like hard cheeses, sour cream, green grapes, pineapple, grapefruit, and alcohol
Drinking alcohol
Eating spicy foods
Taking in excess salt
Consuming too many sour, sweet, or sugary foods
Eating uncooked foods
Eating foods that cause acid reflux
Smoking. Multiple studies show that cigarette smoking increases a person's risk of developing RA and can make the disease worse.

PRECAUTIONS TO BE TAKEN BY THE PATIENTS WITH CERVICAL SPONDYLOSIS

Avoid lifting heavy weights and straining the neck
Take breaks in-between work to give rest to the neck.
Adequate water intake should be maintained
Regular exercises
Weight gaining should be avoided
Maintain a healthy weight: Obesity and excess weight puts pressure on joints and bones.

PREVENTION

Because ankylosing spondylitis has no known cause, there isn't any way to prevent it.

WHY AROGYA RAKSHA FOR ANKYLOSING SPONDYLITIS!

Our ankylosing spondylitis ayurveda treatment method provide a very effective solution.
It alleviates the need for powerful drugs and prevents the need for surgery.
It greatly enhances quality of life.
Our qualified doctors, high quality medicines and treatments makes us the best at offering the services required to effectively heal.
The Ayurveda treatment offered is time-tested, safe and effective.
The Ayurvedic treatment is natural and holistic.
Our comprehensive approach helps retard the chances of a recurrence.
Patients can continue to live life with renewed confidence.