Ankylosing spondylitis is a chronic inflammatory rheumatic disease that mainly affects the spine (spondyl refers to the Greek spondylos vertebrae). Other areas can be affected such as the joints of the limbs, tendons, and ligaments. Ankylosing spondylitis is an autoimmune disease in the category of spondyloarthropathies, one of the characteristics of which is the presence of enthesitis (inflammation of the area where tendons attach to bone). It can also affect the eye (uveitis) and more rarely the heart or lungs. Ankylosing spondylitis affects men more than women (2.5 to 1) and usually begins between the ages of 15 and 35. It is therefore a disease of adolescence and young adulthood that can evolve over time or go into remission after a certain period.
The main symptoms
They consist of pain in the lower back and in one buttock, radiating to the back of the thigh, which may resemble sciatica. These pains often occur at night and are followed by morning stiffness that can take several hours to disappear. Unlike other conditions, exercise helps alleviate the pain caused by ankylosing spondylitis. Ankylosing spondylitis can also manifest as a decrease in movement capacity in the back and chest. Breathing capacity may also be reduced. Sometimes, the joints of the hips, knees, or shoulders are affected, as well as the heel, which is the site of pain corresponding to enthesitis. Chronic inflammation of the intestine, psoriasis, or eye inflammations called uveitis may be associated with ankylosing spondylitis. In severe and advanced cases, the spine can gradually become completely rigid (referred to as total ankylosis or "bamboo spine"), which can lead to significant functional disability because spinal mobility is greatly reduced.
The diagnosis of ankylosing spondylitis is based on the signs and symptoms previously mentioned. However, in order to establish a differential diagnosis, blood tests, X-rays, and MRI scans are often requested. Furthermore, while not a hereditary disease, a genetic factor has been identified. Thus, it is noted that 90% of individuals suffering from ankylosing spondylitis (and uveitis) carried the HLA-B27 gene.
Treatments for ankylosing spondylitis
As with all inflammatory rheumatic diseases, the treatment of ankylosing spondylitis aims to relieve the patient by acting on the pain and mobility of the affected limbs and spine. It is long-term to prevent complications that may appear in the long term. The main drug treatments for ankylosing spondylitis are non-steroidal anti-inflammatory drugs (NSAIDs).
Functional rehabilitation and physiotherapy play a large part in the non-drug treatment of the disease. Several specialists including physiotherapists, occupational therapists, doctors, and functional re-educators can help people disabled by ankylosing spondylitis. The goal is to work on mobility by doing stretching exercises for the neck, trunk, shoulders, and hips, and respiratory exercises aimed at mobilizing the ribs. Corticosteroids are rarely used as a treatment for ankylosing spondylitis. However, they can be useful in intra-articular injection (infiltrations). In recent years, biologics (medications derived from substances in the human body) such as TNF-alpha inhibitors have also been used.
The contribution of nutrition therapy
According to Jean Seignalet, author of the famous book "Alimentation ou la troisième médecine" (Nutrition or the Third Medicine), intestinal permeability is one of the causes of inflammatory reactions and autoimmune diseases such as ankylosing spondylitis because it allows the abnormal passage into the body of protein fragments that are not recognized by the immune system, thus causing an inappropriate immune response. In order to fight against the chronic inflammation that follows, Jean Seignalet proposes in his diet the adoption of a number of dietary rules, which have also been taken up by other authors, to act on inflammation without taking medication. These dietary rules are based on the avoidance of gluten and dairy products, alcohol, tobacco, sodas, and coffee. He also recommends gentle cooking methods (below 110°C) by prohibiting the use of microwaves, as well as the choice of an organic diet rich in omega-3 (fatty fish and organic virgin vegetable oils consumed raw). Finally, he recommends supplementation with vitamins, minerals, and probiotics.