Ankylosing spondylitis (AS) is a type of arthritis (inflammation of the joints) that mainly affects the spine but can also cause inflammation in other parts of the body. 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 can develop, including breathing problems, lung infections, difficulty walking or standing, chronic stooping and, eventually, fusion of the spine. However, symptoms vary widely from person to person, and there's no set course.
Conventional treatment usually includes painkillers and anti-inflammatory drugs like NSAIDs (nonsteroidal anti-inflammatory drugs), or sometimes anti-tumor necrosis factor (TNF) drugs, but all of these come with potentially serious side-effects.
Fortunately, there are drug-free options that can work. Here's a roundup of the best for you to pass on to your friend.
Switch to a low-starch diet
AS has been linked to an overgrowth of the bacteria Klebsiella in the gut, which depends on dietary starch for growth. Research suggests that adopting a low-starch diet, which deprives the bacteria of its nourishment, may be beneficial for people with AS. In fact, one study found that cutting down on bread, potatoes, cakes and pasta led to less inflammation and fewer symptoms in AS patients.1
Try ditching starchy foods from your diet and see if works for you. It may take at least three or four months to start noticing any improvements.
Go for omega-3s
Well-known for their anti-inflammatory properties, omega-3 fatty acids—found in fish oils—have consistently been shown to benefit people with rheumatoid arthritis, reducing pain and swelling.2 Less research has been done in AS patients, but one trial reported that those taking high doses of omega-3 (4.55 g/day) experienced a significant reduction in disease activity compared with those taking a lower dose (1.95 g/day).3
Suggested dosage: Try a high-dose formula such as Bare Biology's Lion Heart Omega 3 Fish Oil Liquid, which supplies 3,000 mg of EPA and DHA per teaspoon
Infrared saunas, which use infrared light waves to heat the body, may help relieve symptoms of AS. Eight 30-minute sauna sessions over four weeks led to short-term improvements in pain, stiffness and fatigue in 17 sufferers, with no adverse effects.4
To try the treatment for yourself, check out local spas. Or you can purchase a portable sauna for home use from companies such as Firzone (www.firzone.co.uk) and Durherm (www.durherm.com).
Opt for gentle exercise
Exercise has been shown to benefit people with AS—especially low-impact types that involve stretching and strengthening and focus on joint mobility, such as Pilates and tai chi. Pilates training three times a week for three months significantly improved physical function in AS patients in one study,5 while an hour of tai chi twice a week for four months reduced AS symptoms and boosted flexibility in another.6 Ideally, find an instructor who can offer one-on-one sessions tailored to your needs and symptoms.
Find a physio
A physiotherapy technique known as Global Posture Re-education (GPR) can work well for AS. An individualized program of static postures designed to stretch and strengthen AS-shortened muscle groups and improve postural symmetry, GPR was more effective than a conventional exercise program at improving symptoms and mobility in one study of 45 sufferers.7 The positive effects on mobility were even evident one year later.8
You should be able to find a physiotherapist near you offering GPR by searching online or asking your doctor. If you can't, try standard physiotherapy, which can also have good results with AS.9
Have a (therapeutic) bath
Balneotherapy, a form of therapeutic bathing found in spas worldwide, can be helpful for AS. Some treatments use normal tap water, while others use natural thermal or mineral waters. Twenty-minute sessions five times a week for three weeks proved to be more effective than NSAIDs for alleviating AS symptoms in one study.10
Bugs in the system
Klebsiella is a ubiquitous bacteria normally found in the digestive tract, but as pioneering immunologist Professor Alan Ebringer of King's College, London, and other researchers discovered, the bacteria is much more common in the stool samples of patients with AS compared to controls, and AS patients have elevated levels of antibodies against Klebsiella compared to healthy people.1
Other studies have revealed that the vast majority of AS patients possess a version of the HLA gene called HLA-B27, although it's fairly rare in the general population. Each version of the HLA gene produces a slightly different end product, a type of protein called a surface recognition antigen, but they all have the same function: to serve as a sort of molecular passport that helps the immune system differentiate the body's own cells from foreign invaders.
Intriguingly, the Klebsiella microbe
has molecular sequences that resemble HLA-B27. Professor Ebringer hypothesized that the presence of Klebsiella in HLA-B27-positive individuals can cause the immune system to become confused and produce antibodies to its own tissues in a process called 'molecular mimicry'—and it's this reaction that causes the symptoms of AS.
As Klebsiella depends on dietary starch to survive, Professor Ebringer proposed that a low-starch diet—avoiding the "four major poisons" of bread, potatoes, cakes and pasta—may be beneficial for patients with AS, and he used this diet at his clinic with great success until his retirement.
In a controlled study, a low-starch diet led to reduced antibody levels in the blood as well as symptoms and measures of inflammation in AS patients.2