Ankylosing Spondylitis (AS) is an inflammatory disease affecting mainly the pelvic (sacroiliac) region. It affects young males about four times as often as females. Onset typically occurs between the ages of 15 and 45.
What is it?
The exact cause is not fully understood, but it is classified as an autoimmune disorder, which means that the body's immune system is attacking some of its own cells causing ongoing inflammation. It is classified as one of the so-called sero-negative arthropathies (the rheumatoid factor is not present).
As it progresses, ossification is triggered by the body's defense mechanism. Ossification causes new bone to grow along the ligaments between vertebrae gradually limiting movement and eventually fusing them together. Further, ossification may affect spinal ligaments causing narrowing of the spinal canal (central stenosis), which can result in compression of nerves but this is very rare.
The main presenting complaints in the early stages are lower back pain with morning stiffness that often wares off during the day with activity. In some cases the inflammation can be so severe that the pain is constant and severely disabling, but this is rare.
The pain and stiffness can progress to affect the mid back and neck, and in about a quarter of people with AS it affects the joints in the limbs, with the hips being the most common, affecting half the people with AS.
If the chest and ribs are affected, it can make it difficult to take a deep breath. The legs can become weak and numb if certain nerves are pinched or trapped but this is very rare.
What tests will the chiropractor do to confirm AS?
At Advanced Healthcare, Dr. Pisarek will first review your general health and family medical history. It is important for him to know if any family member has had the problem. A family history of AS may be indicative in diagnosing this condition, but it is not necessary.
During the physical examination, you will be asked to move and bend in different ways so the chiropractor can see how flexible your spine is. In the early stages subtle changes can be significant. In a later stage the mobility can be significantly reduced.
Dr. Pisarek will also check your chest expansion which can be reduced in AS. He will also conduct a neurological examination.
If the findings in the history taking and examination suggest that you may have AS, Dr. Pisarek may suggest X-rays. The signs on X-rays are usually quite characteristic and if the findings correlate with the history and examination, a diagnosis can often be made with good accuracy.
However, he would inform your GP and normally suggest that you have blood and/or urine tests taken to support our diagnosis.
A blood sample, prescribed by your MD, may be taken to look for an antigen called HLA-BA27, which is positive 96% of the time. But the presence of HLA-BA27 does not mean that you have AS for sure. It is just an indicator that you may have it. (An antigen is a protein that helps the body to make antibodies to fight infection.)
Blood tests are usually negative for rheumatoid factor, which will rule out Rheumatoid arthritis. ESR is usually raised. This is an indication that your body is fighting an inflammation.
There are very characteristic signs on x-rays that the chiropractor can look for. In the early stages there is a widening of the pelvic (sacroiliac) joints (SI) with irregularity of the joint surface and sclerosis (whitening of the bone). There may be squaring of the vertebrae and mild calcification of the outer part of the discs (causing what is called 'shiny corner signs' and syndesmophytes). In the later stages when the condition has been present, usually for many years, fusion may occur causing a so called 'bamboo spine'.
A CT or MRI scan may be ordered by your MD to view the spine in greater detail, especially if the x-rays do not correlate with the findings in the history and examination.
Why do I need all these tests?
When it comes to diagnosing a medical condition, one or a collection of symptoms can have many causes. For example in AS, the most common presentation is pelvic (sacroiliac) joint pain from inflammation of the sacroiliac joint. Sacroiliitis (inflammation of the sacroiliac joint) can have many causes. It can be caused by Psoriatic arthritis, Reiter's syndrome, Ulcerative colitis or infection, to mention a few. But by doing various tests one or the other condition can be ruled out. This is of course important so the most appropriate treatment can be given.
Chiropractic Treatment of AS
The medical treatment includes prescribed non-steroidal anti-inflammatory medication, opiod analgesics and physical therapy. In severe cases of AS, surgery can be an option in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered very risky.
Medical professionals and experts in AS have speculated that maintaining good posture can reduce the likelihood of a fused or curved spine which occurs in a significant percentage of diagnosed persons. This is where natural based chiropractic care comes in.
In severe cases of AS, surgery can be an option in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered very risky.
However, non-medical treatment includes various 'supportive' chiropractic adjustment mobilization therapies, physical therapy modalities, stretching and strengthening exercises, low-level laser therapy (LLLT) and lifestyle modification techniques.
With respect to physical therapy, some of the therapies that have been shown to benefit AS patients include: exercise programs, either at home or supervised, are better than not having an exercise program; Group exercises are better than home exercises; and extending regular group exercises with few weeks exercising at a spa resort is better than group exercises alone. Moderate-to-high impact exercises like jogging are generally not recommended or recommended with restrictions due to the jarring of affected spinal vertebrae and joints that can worsen pain and stiffness in some patients.
Dr. Pisarek will show you exercises designed to strengthen your back, improve posture, increase flexibility, range of motion, and techniques to improve your breathing. We normally also use spinal manipulation of a kind that is safe and comfortable for you.
Because chiropractors specialize in treatment of lower back pain and usually have X-ray facilities on-site, they often pick up when patients have AS early on. Unfortunately, in some cases patients in past have been told by their medical practitioner that chiropractic treatment is not appropriate for them. But it is important to know that 'supportive' chiropractic treatment is a very helpful, safe and effective way of managing your AS.
We have had several patients over the years that have found that chiropractic treatment has maintained their mobility, improved their function and therefore helped to control their pain.
There is no doubt that anti-inflammatory medication will help if the inflammation is particularly bad. So ideally you should be co-managed. Which means that your GP and/or rheumatologist and chiropractor should both be involved.
Medical prognosis is related to disease severity. AS can range from mild to progressively debilitating and from medically controlled to refractory. Some cases may have times of active inflammation followed by times of remission resulting in minimal disability, while others never have times of remission and have acute inflammation and pain, leading to significant disability.
Over a long-term period, osteopenia or osteoporosis of the AP spine may occur, causing eventual compression fractures and a back "hump". Typical signs of progressed AS are the visible formation of syndesmophytes on X-rays and abnormal bone outgrowths similar to osteophytes affecting the spine. The fusion of the vertebrae paresthesia is a complication due to the inflammation of the tissue surrounding nerves.
Organs commonly affected by AS, other than the axial spine and other joints, are the heart, lungs, eyes, colon, and kidneys. Other complications are aortic regurgitation, Achilles tendinitis, AV node block and amyloidosis. Owing to lung fibrosis, chest X-rays may show apical fibrosis, while pulmonary function testing may reveal a restrictive lung defect. Very rare complications involve neurologic conditions such as the cauda equina syndrome. Mortality is increased in patients with AS and circulatory disease is the most frequent cause of death.
At Advanced Healthcare, we encourage co-operation between medical and complementary practitioners to give you the best possible care.
Call Dr. Pisarek at (416) 633-3000 for an appointment to find out how he can help
your condition and to get started on your "road to recovery".
If your condition is not amenable to natural, painless and non-surgical Chiropractic care,
then you will be referred to a health provider that may help you.