Treat it AS it is...

BE FIRM Lifestyle changes can help manage Ankylosing Spondylitis as ignoring the signs can be debilitating, warns Dr Chandrashekara S

Ankylosing Spondylitis (AS) is an inflammatory and autoimmune disease that largely affects the spine and results in pain in the lower back, pelvis, and buttocks as some of the major symptoms, though the disease can affect the entire body.

While the percentage of patients globally may seem small, nearly one in 100 adults live
with this chronic condition, where the spine’s bones fuse together resulting in the spine becoming rigid.

Medical experts are aiming to raise more awareness about this irreversible, autoimmune disease for better diagnosis and management.

According to research, diagnosis of AS is usually delayed by an average of seven to 10 years. In the initial phase of the disease, patients often perceive the symptoms as regular back pain and this usually delays the diagnosis.

Many times, patients are not even aware that such symptoms may require consultation and treatment by specialised doctors.

If you are diagnosed with AS, your rheumatologist will most likely start you on a medication regimen that may include NSAIDs (non-steroidal anti-inflammatory drugs), progressing to disease-modifying drugs or biologics like TNF blockers that help control the disease’s symptoms and progression, thereby delaying the fusion of bones. As soon as you are on appropriate AS medication, it is also very important to incorporate lifestyle changes to help manage symptoms before they become even more debilitating.

Here are a few lifestyle tips that can help in managing AS:

Exercise: Severe stiffness experienced in the lower back, pelvis and buttocks early in the mornings is a common symptom of AS, which can be controlled with proper exercise. Therefore, maintaining a regular exercise regime can help slow down the progression of the disease. If extensive stiffness is not allowing you to exercise, it is advisable to start with a few warm up exercises. In case you are suffering from too much pain in the mornings, you can also choose to exercise during the afternoon. However, before attempting any exercises, it is advisable that one seeks guidance from a physiotherapist. Also, make sure you don’t slouch at your work desk or seat, which can also contribute to stiffness and poor posture.

Use firm mattress: Although you cannot completely control your posture while sleeping, you can get started by sleeping on your back on a firm mattress with no pillow under your knees or head. Since pain may seem more severe at night, you need a good mattress to reduce the discomfort while sleeping.

Medication: Pain that wakes you up in the second half of the night is common among people with AS. Lying still for too long also contributes to painful inflammation and stiffness. You may want to talk to your rheumatologist about your medications that can provide you relief.

A warm bath: Medical experts have pointed out that a warm bath or shower can be very helpful to relieve the pain and stiffness of Ankylosing Spondylitis. Stretching exercises to relieve pain and stiffness are also better after a warm shower. Another natural pain relief strategy is to alternate hot and cold compresses on the painful areas of the body.

Acupuncture & massage: A massage can help you feel relaxed and prepare you for your exercises. Additionally, acupuncture therapy can help in activating your body’s pain-relieving hormones. However, before opting for these massage therapy options, it is very important to consult a physiotherapist who has specialised training on managing AS.

Stop smoking: Medical experts have remarked that smokers, especially men, are at a greater risk of spine damage from AS than non-smokers. Quitting smoking not only helps reduce further progression of AS, but also improves the overall health.

(The author is managing director, ChanRe Rheumatology & Immunology Centre and Research, Bengaluru)