Chiropractic and Ankylosing Spondylitis
Saturday, March 14, 2015 04:16 PM

ACCORDING TO THE SPONDYLITIS ASSOCIATION OF AMERICA, ankylosing spondylitis (AS) is a form of arthritis that primarily affects the spine, although other joints can become involved. It causes inflammation of the vertebrae, which can lead to severe, chronic pain and discomfort. In the most advanced cases (but not in all), this inflammation can result in new bone formation on the spine, causing it to fuse in a fixed, immobile position, sometimes creating a forward-stooped posture. This forward curvature is called kyphosis.

It is important to differentiate between mechanical and inflammatory back pain when diagnosing patients. When dealing with mechanical back pain, usually a patient will rest and then feel better; while often the pain will last only a month or two. “With inflammatory back pain, they feel stiff, and it worsens with rest or inactivity, and it occurs early morning and later at night,” he says. “If they exercise, it feels a little bit better, and it lasts more than three months.”

AS is one of a family of disorders known as spondyloarthritis.  AS is inflammatory and mechanical, which is a relatively new concept. He explains that patients show symptoms of pain and localized swelling when the ligament attachment to the spine joint called the entheses is inflamed, which is relatively common. The term enthesitis speaks to an inflammatory focus when that ligament causes the pain. “Eventually the cartilage in the joint disappears, the ligaments are inflamed, joints don’t move and you lose mobility. Enthesitis is one of the principal causes of pain in any spondyloarthritis. These are relatively new ideas that enthesitis is the key pathological lesion in spondyloarthritis, and that includes AS.

AS is an axial disease but has peripheral components, so a patient can develop arthritis outside the spine. AS disease is multisystem. “The patient care always should be coordinated with a rheumatologist; this has to be a multidisciplinary approach, both in diagnosis and in treatment. DCs need to have consultations through a rheumatologist because there can be involved heart disease, eye disease and many areas of the body.” The disorder has diminished life expectancy even with early diagnosis.

AS can also cause inflammation, pain and stiffness in other areas of the body, such as the shoulders, hips, ribs, heels and small joints of the hands and feet. Sometimes the eyes can become involved (known as iritis or uveitis), and rarely, the lungs and heart can be affected. The hallmark feature of AS is the involvement of the sacroiliac (SI) joints during disease progression. It is more common in men than women. There is no known cause or cure of AS, but the symptoms can be treated. There is a genetic component to AS, and the HLA-B27 is an antigen that is positive in 90 percent of the cases.

Symptoms can be managed and chiropractic manipulation provides some relief. Manipulation should be limited to the non-acute inflammatory stage. “Manipulation should not be performed in an acute joint disease as that will cause injury in the connective tissue.”

Read much more in the source article cited below.