HOLISTIC COMPREHENSIVE APPROACH TO CONQUER ANKYLOSING SPONDYLOSIS WITH HOMOEOPATHIC MODALITY

 

Abstract

 

Ankylosing spondylosis (AS) is a chronic inflammatory rheumatic disorder primarily affecting the axial skeleton, causing progressive stiffness, postural deformity, and restricted mobility. It is closely associated with HLA-B27 positivity, signifying a strong autoimmune component. Conventional management relies on NSAIDs, corticosteroids, and biologics, which may provide temporary relief but often lead to adverse effects such as gastric irritation and steroid dependency.

 

Introduction

 

Ankylosing   spondylosis   (AS) is   a chronic    progressive    inflammatory    arthritis primarily involving the sacroiliac and spinal joints, leading    to    ankylosis    (fusion) and postural   deformity.   The   global   prevalence ranges between 0.1 %–1 %, with a strong genetic correlation to HLA-B27, found in over 90 % of affected individuals. It may cause discomfort, stiffness, and potential spinal fusion. It typically starts in the lower back and pelvis before progressing to other spine areas. The disease typically begins in adolescence and young adulthood, and only rarely does it begin after the age of 45 years. Male to female ratio is 3:2.

Greek – ankylos, meaning bent,

Greek – spondylos, meaning vertebra; – itis, meaning inflammation

Spondylitis means inflammation of the spinal vertebrae. The name therefore suggests that AS is an inflammatory disease of the spine that can lead to stiffening of the back.

 

Causes of Ankylosing Spondylitis

Many variables, including immune system dysfunction and genetic predisposition, are thought to contribute to ankylosing spondylitis.

Genetic Predisposition

Ankylosing spondylitis is strongly linked to the HLA-B27  (Human Lymphocytic antigen) gene found in most patients with AS. This gene significantly increases the likelihood of getting the illness, especially in those who have a family history of AS.

Autoimmune Response

An autoimmune condition called ankylosing spondylitis causes persistent inflammation when the body's immune system unintentionally targets healthy joint structures. Over time, this inflammation may lead to the vertebrae of the spine fusing together, decreasing its flexibility.

Clinical manifestations

Spinal features

Early physical signs include failure to demolish the lumbar lordosis on forward flexion, pain on sacroiliac compression, and restriction of movements of the lumbar spine in all directions.

Symptoms are most marked in the early morning and after inactivity and are relieved by movement. As the spine becomes progressively ankylosed, spinal rigidity and secondary osteoporosis predispose to spinal fracture, presenting as acute, severe, well localised pain. Secondary spinal cord compression is a rare complication.

The characteristic symptom of AS is sacroiliitis, the inflammation of the sacroiliac joints. The pain caused by sacroiliitis is usually a dull diffuse ache, not localized, felt deep in the buttock area. In starting, it may be intermittent or on one side only, or alternate between sides; however, within a few months it generally becomes persistent and is felt on both sides.

Bilateral sacroiliitis. Frontal radiograph shows bilateral sacroiliac joint erosions and iliac side subchondral sclerosis

Progressively the lower back becomes stiff and painful, with the inflammation extending to the spine. With time, the back pain can gradually extend up the spine. These initial symptoms usually start in late adolescence or early adulthood.

The characteristic symptom is chronic low back pain and stiffness that have come on gradually, for no apparent reason.

Enthesopathy - The inflammation in AS tends to start at the places where joint capsules, ligaments or tendons are attached to bone, resulting in pain or tenderness at these sites. The name enthesis is given to these sites, and the inflammatory lesion is called enthesitis or sometimes enthesopathy.

Scarring and bone formation - A process of healing and repair, which follows the enthesitis phase, results in gradual limitation of back motion due to scarring and subsequent bone formation. This process may, after many years, lead ultimately to complete spinal fusion.

Sclerosis of the bones - The inflammatory changes affect the annulus fibrosus especially at its attachment to the corners of the vertebral bodies, resulting in increased bone density, called as sclerosis of these corners. The bone at these corners may subsequently disappear, and this may ultimately result in squaring of the vertebral bodies.

Syndesmophyte - Gradually a thin layer of vertical bony outgrowths at the edges of the vertebrae bridges the gap between the two adjacent vertebral bodies, replacing the superficial layer of the annulus fibrosus of the disc. This intervertebral bony bridging that surrounds the disc is called a syndesmophyte.

Spinal fusion and Bamboo spine - At the same time, inflammatory changes and slowly progressive bony fusion may be going on in spinal joints called the apophyseal or facet joints. With severe disease, the inflammatory process of the spine may gradually, after many years, result in complete fusion called bony ankylosis of the whole spine. The X-ray of the spine may ultimately look like a bamboo and is sometimes called bamboo spine.

Spinal osteoporosis is also frequently observed among such patients, partly as a result of the lack of spinal mobility and aging.

Extraspinal features

‘Pleuritic’ chest pain aggravated by breathing results from involvement of the costovertebral joints. Plantar fasciitis, Achilles tendinitis and tenderness over bony prominences such as the iliac crest and greater trochanter result from inflammatory enthesopathy.

Fatigue is often a major complaint and may result from chronic interruption of sleep due to pain and from chronic systemic inflammation.

Extraspinal synovial joint involvement is usually asymmetrical at first and may cause inflammatory symptoms mainly affecting hips, knees, ankles or shoulders. Involvement of a peripheral joint (mainly ankle, knee or elbow) precedes the development of spinal symptoms. In childhood pauciarticular juvenile idiopathic arthritis may develop.

The inflammation of the costovertebral and costotransverse joints, and at the costochondral areas, can result in chest pain and tenderness. This pain can be aggravated by coughing or sneezing. Gradually chest expansion may be decreased

O/E: “Schober test”:  Flexion of lumber spine is measured by the schober test.

Two points are taken in an erect posture; one is 5cm below & other is 10cm above the lumbosacral junction. The patient bends forward maximally, and the distance between the two marks is measured. The distance between the two marks increases to 5 cm or more in case of normal mobility and less than 4cm in case of decreased mobility. Springing the pelvis ( pressing iliac crest towards each other) causing sacroiliac pain.

 

Diagnosis of AS

The generally accepted criteria for AS (modified New York criteria)

• Low back pain of at least 3 month’s duration improved by exercise and not relieved by rest
• Limitation of lumbar spinal motion in sagittal (sideways) and frontal (forward and backward) planes
• Chest expansion decreased relative to normal values for the same sex and age 4- Bilateral sacroiliitis grade 2–4 or unilateral sacroiliitis grade 3 or 4

Investigations

Imaging Studies

• X-rays and MRI scans can detect sacroiliitis (inflammation of the sacroiliac joints) and changes to the spine that suggest AS. An MRI can show early inflammation before changes are visible on X-rays.

Blood Tests

• Blood - Increased  ESR or May be normal, Normochromic, Normocytic anemia
• Immunological Test - RA Factor (–)ve, ANA Factor (–)ve, Test for HLAB-27 Antigen is positive in 80- 90 % of cases.

Management

• Conventional treatments focus on pain relief, inflammation reduction, and maintaining mobility.
• Medications - NSAIDs like Ibuprofen and other nonsteroidal anti-inflammatory medications are frequently used to treat pain and lower inflammation. In severe cases, biological agents like TNF inhibitors and IL-17 inhibitors are used to modify the disease process.
• Physical Therapy and Exercise - To preserve flexibility and stop the advancement of spinal fusion, regular exercise and physical treatment are crucial. Low-impact exercises are recommended for patients to maintain posture and gain muscle.
• Heat and Cold Therapy - Applying warm and cold to influenced regions can offer assistance calm aggravation and muscle fits, giving short-term torment help.
• Surgery - In extreme cases, surgery may be necessary to correct joint deformities, decompress the spine, or replace damaged joints.

Lifestyle Management

Way of life changes are fundamentally to overseeing ankylosing spondylitis. These alterations can decrease side effects, make strides portability, and improve the in general quality of life.

Exercise and Physical Activity - Low-impact exercises like swimming, yoga, and stretching are essential for maintaining flexibility and spinal health. Patients should aim for regular exercise to improve posture and prevent stiffness.

Posture Management - Keeping proper posture reduces strain on the spine and joints, particularly when standing or sitting for extended periods of time. Think about making your house and workplace more ergonomic.

Dietary Modifications - A well-rounded diet full of items that reduce inflammation, like omega-3 fatty acids, green leafy vegetables, and turmeric can help reduce systemic inflammation. Avoiding processed foods, sugar, and excessive dairy can also be beneficial.

Stress Management - Mindfulness, unwinding strategies, and profound breathing works out can offer assistance oversee the passionate affect of living with a incessant condition like AS. Diminishing push and advancing generally well-being.

Sleep Hygiene - Keeping up great rest cleanliness and guaranteeing satisfactory rest is vital for mending and in general wellbeing. Patients ought to point for a reliable rest plan and utilize strong bedding to avoid inconvenience amid rest

 

HOMOEOPATHIC MANAGEMENT

 

Homoeopathy is a remarkable resource for those dealing with joint disorders. Homeopathic constitutional treatment based on the individual case is the most suitable and would aim to heal the underlying physical or emotional crisis causing rheumatological disorders. The unique physical, emotional and mental expression of illness is characteristic and is used to channel the course of Homoeopathic treatment. The remedies work by stimulating body’s natural ability to heal itself, acting as a catalyst for healing. Homoeopathy can be of assistance in retrieving normal motility and treating any psychological issues related. Homeopathic remedies can help rebuild mind, body and spirit as well as personal relationships for a balanced lifestyle. Homeopathy will reinforce and tone the body’s systems. Homeopathic remedies can help deal with anxiety, depression, and stress along with rheumatological problems. It will attend to nutritional problems and help the patient develop a healthier body image.

 

Some Homoeopathic remedies for AS are

 

Indicated Remedies	Indications
Aurum metallicum	Serious or advanced rheumatism with marked stiffness. Rheumatism with stiffness or spasms of the chest wall. Severe spasm or tearing pains. Pains also described as “paralytic.” An important remedy in ankylosing spondylitis. Wandering arthritis; moving spot to spot from one week to next. Worse: Night. Morning in bed. Hip pain worse rising from a seat or from walking. Chest wall pain and spasm worse first motion and inspiring. Better: Motion. Location: Wandering arthritis. Back. Chest and ribs. Hip.
Butyricum acidum	Morbus coxae senilis. Ankylosing spondylitis. Tired feeling and dull pain in small of back, worse walking. Pain in ankles and up back of leg. Pain low down in back and limbs.
Colchicum autumnale	Pain with ankylosis of the back and neck. Burning pain in the neck, ameliorated by movement. Pain in the renal region. Pain in the left scapula, aggravated on waking, by movement, and by lying on the left side. Ankylosing arthritis of the vertebral joints. Noninflammatory chronic rheumatism of the hip and knee.
Cuprum metallicum	Cramps in calves and soles. Jerking, twitching of muscles in hands and feet. Clenching of thumb in palms. Cramps in palms, calves and soles. Coldness of hands. Joints contracted. Great weariness of limbs. Ankles painfully heavy. Ankylosis of shoulder joint. Knees double up involuntary when walking, bringing him down.
Dichapetalum	Fatigue and rheumatic pains in the limbs, and legs feel like rubber. Heaviness in the calves. Stiffness at the nape of the neck , with pain starting at the 7th cervical vertebra, spreading up the nape and accompanied by right frontal hemicrania. Pain between the shoulders.
Kalium iodatum	Weakness, emaciation. Arteriosclerosis. Cachexia. Contraction of muscles and tendons, chronic arthritis with spurious ankylosis.
Mercurius solubilis	Local signs of inflammation, marked deformity, extreme atrophy of muscles, swelling of soft parts, subcutaneous nodules, fibrous or bony ankylosis. Marked deformity, extreme atrophy of muscles, swelling of soft parts, subcutaneous nodules, fibrous or bony ankylosis. Marked pain.
Phosphorus	Paralysis of spine, especially the sacrum, from spondylitis. The chest becomes rigid or immovable. Pain, heat and burning in the spine and sciatic nerve. Sensitive, tender spinous process – especially the dorsal spine. An important remedy in ankylosing spondylitis with rigid spine and fixed chest wall. Worse: Cold. Rising from a seat. Lying on the left side.  Laughing. Crossing the legs in bed. Better: Heat. Lying on right side or on back. Rubbing. Motion.
Radium bromatum	In Europe, Ra-224 [isotope with a half-life of about three and a half days] was used for more than 40 years in the treatment of tuberculosis and ankylosing spondylitis.
Rhus Toxicodendron	ANKYLOSIS. Numbness and formication, after overwork and exposure. Tension as from shortening of muscles. Numbness of limbs on which he lies; esp. arms. Stiff and paralysed sensation in joints from sprains, overlifting and overstretching. Internal coldness in limbs. As if skin around diseased parts were too tight. PA Tearing, in tendons, ligaments and fasciae. Rheumatic, spread over a large surface at nape, loins, and limbs; amel. motion [Agar.]. Soreness of condyles of bones. 5 Rheumatic gnawing, & desire to move limbs frequently, which amel.. Drawing or tearing, in limbs during rest. OB Hot, painful swelling of joints. Limbs stiff, paralysed. Paralysis; trembling after exertion.
Silicea terra	Synovial cysts.  Enlarged bursa over patella.  Large cyst on patella; not inflamed but extremely sensitive.  Chronic synovitis of knee with great swelling and ankylosis. Icy coldness of feet; or foot-sweat, often very offensive; or suppressed foot-sweat.
Viscum album	Arthrosis. Painful post-traumatic osteoporosis, linked with vaso-motor and tropho-cutaneous complaints. Dupuytren’s disease. Periarthrosis of the scapula and humerus. Arthrosis of the hip. Ankylosing spondylitis. Gonococcal rheumatism. Juvenile growth disorders.
Wiesbaden aqua	Rheumatism and gout. Abdomen full and tense. Passive or atonic gout. Contractions of muscles and tendons. Complete ankylosis. Stiffness of old fractures.
Thuja Occidentalis	Recommended for those with a family history of autoimmune diseases and chronic complaints.

 

Conclusion

A comprehensive approach to overseeing ankylosing spondylitis includes customary medicines and homeopathic care. Whereas conventional medications like NSAIDs and physical treatment address the prompt indications, homeopathy offers long-term help by centering on person side effects and in general wellbeing. Customary checking and way of life alterations are basic for ideal administration of this constant condition. With a personalized treatment plan, lifestyle management, and the support of a homeopathic practitioner, patients with ankylosing spondylitis can experience improved mobility, reduced pain, and an enhanced quality of life.