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What Doctors Don't Tell You

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July 2020 (Vol. 5 Issue 5)

Ankylosing spondilitis

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Q) My 22-year-old son has recently been diagnosed with ankylosing spondylitis

Q) My 22-year-old son has recently been diagnosed with ankylosing spondylitis. Can you recommend any treatments besides drugs?-C.S., via e-mail

A) Ankylosing spondylitis (AS) is an inflammatory arthritis that primarily affects the spine. It usually starts in the late teens and early 20s, causing pain and stiffness in the lower back and hips. In its advanced stages, more severe symptoms and complications arise, including breathing problems, lung infections, difficulty walking or standing, chronic stooping and, eventually, fusion of the spine. However, there's no set course, and symptoms vary widely.

Although there's no known cure for AS, a variety of treatments may be able to help. Anti-inflammatory drugs and painkillers are the doctor's usual first port of call, but there's also a number of promising alternative therapies that don't come with dangerous side-effects.

For starters, your son might consider a change of diet, as AS has been linked to an overgrowth of the harmful bacteria Klebsiella in the gut, which depends on dietary carbohydrates for growth. Research suggests that adopting a low-carb diet, which deprives the bacteria of its nourishment, may be beneficial for people with AS. Indeed, one study found that reducing the intake of bread, potatoes, cakes and pasta led to less inflammation and fewer symptoms in AS patients (Clin Rheumatol, 1996;

15 Suppl 1: 62-6). However, no further studies have been published to confirm this finding.

Perhaps more convincing is the evidence showing omega-3 fats to be useful in the treatment of AS. Fish oils are well-known for their anti-inflammatory properties, and numerous studies have found supplementation to be effective against rheumatoid diseases, particularly rheu-matoid arthritis (Reumatismo, 2008; 60: 174-9). In patients with AS, those taking high doses of omega-3 (4.55 g/day) experienced a significant decrease in disease activity compared with those taking a lower (1.95 g/day) dose (Scand J Rheumatol, 2006; 35: 359-62).

Besides diet, there is also evidence that exercise can influence AS. In fact, the American Society of Ankylosing Spondylitis (ASAS)/European League Against Rheuma-tism (EULAR) recommendations for the management of AS include exercise therapy among their 10 final, expert-selected options (Ann Rheum Dis, 2006; 65: 442-52). One study involving 30 AS patients found that an exercise programme that included aerobic, stretching and breathing exercises in conjunction with routine medical care significantly improved spinal mobility, work capacity and chest expansion compared with routine care alone (Phys Ther, 2006; 86: 924-35).

The rehabilitation technique known as the Global Posture Reeducation (GPR) method appears to be especially effective. In this form of therapy-which was specifically developed for AS by a team of physical therapy researchers in Madrid, Spain-specific exercises are employed to stretch and strengthen AS-shortened muscle groups. In a study of 45 AS sufferers, those who underwent weekly group sessions for 15 weeks using the GPR exercise programme achieved greater improvements in their condition than those following a conventional 20-exercise programme (Am J Phys Med Rehabil, 2005; 84: 407-19).

Exercise that incorporates relaxation techniques also appears to be helpful for AS. A South Korean study found that one hour of tai chi twice a week for eight weeks led to significant improvement in flexibility and disease activity compared with no tai chi (Evid Based Complement Alternat Med, 2008 Jul 15; Epub ahead of print). This suggests that other mind-body techniques, such as yoga, may also be beneficial in AS sufferers.

Nevertheless, as AS symptoms vary widely from one person to another, it's probably best to see a physical therapist who can determine the most suitable type of exercise for your son. Indeed, even standard physical therapy under the supervision of a therapist has been shown to improve posture, fitness, mobility, function and mood in patients with AS (Curr Opin Rheumatol, 2008; 20: 282-6).

Something else that may be worth considering is balneotherapy-a form of therapeutic baths found in spas around the world. Some treatments use normal tap water, while others use natural thermal or mineral waters. Research shows that AS patients who combine balneotherapy along with exercise experience greater improvements than those who use exercise alone (Clin Rheumatol, 2008; 27: 913-7; Scand J Rheumatol, 2006; 35: 283-9).

Finally, infrared saunas-another treatment commonly found in spas-may also bring short-term benefits to patients with AS. A Dutch study of 17 sufferers found that four weeks of infrared sauna sessions (eight sessions in total) markedly reduced symptoms of pain, stiffness and fatigue, with no adverse changes in disease progression (Clin Rheumatol, 2008 Aug 7; Epub ahead of print).

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