Ankylosing Spondylitis: Symptoms, Treatment, and Dietary Impact

Ankylosing Spondylitis

I am 30 years old and last year I discovered that the cause of my pain is ankylosing spondylitis.
I underwent blood tests and X-rays, and there are no cases of this condition in my family.
The blood test came back positive, but the X-ray did not show any signs of fusion or calcification.
My range of motion is completely unaffected.
The onset of my symptoms occurred when I woke up one morning and experienced severe pain in my lower body.
Currently, after taking anti-inflammatory medication, I occasionally feel a slight tingling pain (not very intense, just a mild discomfort).
1.
I would like to ask if, after the onset of the disease, I am certain to experience calcification or fusion in the future.
2.
My doctor mentioned that I only need to take medication for two years, and as long as my condition does not worsen, I can stop the medication.
However, when I discuss this with others online, they often say that two years seems too short.
Is two years of medication sufficient?
3.
I first experienced pain in August of last year.
Prior to that, I had no symptoms, and I only had an X-ray done (which showed no abnormalities, just a slight S-shaped curvature) and blood tests.
Do I need to undergo further examinations?
4.
Since the onset of my condition, I have had a sensation where consuming sour fruits, such as oranges, makes my bones feel slightly sore.
It’s not very painful, just a mild discomfort.
Should I have dietary restrictions? (Previously, I had a meat-heavy diet and rarely consumed fruits.)
Thank you, doctor, for your assistance.

Huai Dan, 30~39 year old female. Ask Date: 2005/02/02

Dr. Lin Xiaoyi reply Orthopedics

Dear Mr.
Bad Egg,
1.
It is not necessarily the case that you will progress to ankylosis.
If you have a confirmed diagnosis of ankylosing spondylitis and your X-rays currently show no significant changes, most patients can achieve good control by adhering to medication and rehabilitation exercises, preventing the condition from worsening or even completely halting its progression.
2.
I am unsure if you are currently taking only anti-inflammatory medications.
You can stop taking them when you are not in pain and only take them when you are experiencing discomfort.
However, if you have daily pain, you should continue taking the anti-inflammatory medication as prescribed.
If you are on immunomodulators, you will need to take them daily for about three to five years, but the decision to stop or reduce medication should be made by your physician based on your condition.
Whether you need to take immunomodulators should also be determined by your doctor according to your clinical situation.
3.
You may ask your physician to perform another X-ray.
If there are still no significant changes indicating sacroiliitis, you can further undergo a quantitative sacroiliac joint scan (QSS) using nuclear medicine to determine if you are in the early stages of ankylosing spondylitis.
Additionally, inflammatory markers in your blood (ESR, CRP) and Immunoglobulin A (IgA) can serve as references for diagnosis.
4.
There are no specific dietary restrictions for ankylosing spondylitis, but a balanced and healthy diet is essential.
Avoiding contaminated foods is important to maintain gastrointestinal health, which can be beneficial for your condition.
Wishing you good health,
Lin Hsiao-Yi
Rheumatology and Immunology Department, Taipei Veterans General Hospital

Reply Date: 2005/02/02

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, which can lead to pain and stiffness in the back and hips. It is part of a group of diseases known as spondyloarthritis. Understanding the symptoms, treatment options, and dietary impacts of AS is crucial for managing the condition effectively.

Symptoms of Ankylosing Spondylitis
The symptoms of AS typically include:
1. Chronic Pain and Stiffness: This often starts in the lower back and can extend to the hips and buttocks. The pain is usually worse in the morning or after periods of inactivity.

2. Reduced Flexibility: Over time, AS can lead to a decrease in spinal flexibility, which may result in a hunched posture.

3. Fatigue: Many patients experience fatigue due to chronic pain and inflammation.

4. Peripheral Joint Involvement: Some individuals may also experience pain in other joints, such as the shoulders, knees, and ankles.

5. Extra-Articular Manifestations: These can include eye inflammation (uveitis), skin rashes, and gastrointestinal issues.

Treatment Options
The treatment for AS aims to reduce pain and stiffness, maintain mobility, and prevent complications. Common treatment strategies include:
1. Medications:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are the first line of treatment to help relieve pain and inflammation.

- Disease-Modifying Anti-Rheumatic Drugs (DMARDs): In some cases, DMARDs like sulfasalazine may be prescribed, especially if peripheral joints are involved.

- Biologics: For patients who do not respond to NSAIDs, biologic agents such as TNF inhibitors (e.g., etanercept, infliximab) may be effective in managing symptoms and slowing disease progression.

2. Physical Therapy: Regular exercise and physical therapy are crucial for maintaining flexibility and posture. Specific exercises targeting the spine and hips can help alleviate stiffness.

3. Surgery: In severe cases where joint damage occurs, surgical options may be considered, such as hip replacement.

Dietary Impact
Diet can play a role in managing inflammation associated with AS. While there are no specific dietary restrictions for AS, a balanced diet rich in anti-inflammatory foods may be beneficial. Here are some dietary considerations:
1. Anti-Inflammatory Foods: Incorporate foods high in omega-3 fatty acids (like fish, flaxseeds, and walnuts), fruits, vegetables, whole grains, and nuts.

2. Limit Processed Foods: Reducing intake of processed foods, sugars, and saturated fats may help decrease inflammation.

3. Hydration: Staying well-hydrated is essential for overall health and can help manage symptoms.

Addressing Your Concerns
1. Future Risk of Calcification or Fusion: Not all patients with AS will experience significant calcification or fusion of the spine. Early diagnosis and effective management can significantly alter the disease course. Regular follow-ups with your healthcare provider are essential to monitor your condition.

2. Duration of Medication: The duration of medication varies from person to person. While some may require long-term treatment, others may achieve remission and reduce or stop medication. It’s crucial to follow your doctor’s advice and have regular assessments to determine the best course of action.

3. Need for Further Testing: If your symptoms change or worsen, or if you have concerns about your diagnosis, discussing further imaging or blood tests with your doctor is advisable. This can help in assessing disease progression.

4. Dietary Sensitivities: If you notice that certain foods, like acidic fruits, trigger discomfort, it may be worth discussing this with a nutritionist or your healthcare provider. While there are no strict dietary restrictions for AS, individual responses to foods can vary.

In conclusion, managing Ankylosing Spondylitis involves a comprehensive approach that includes medication, physical therapy, and lifestyle modifications. Regular communication with your healthcare team is vital to tailor your treatment plan and address any concerns you may have.

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