Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis that primarily affects the sacroiliac joints (pelvis), low back, neck, ribs and sternum (breast bone).
AS is thought to have a hereditary link with the HLA-B27 gene being more prevalent in AS individuals. AS is 2-3 times more common in males and can present earlier in life producing back pain and stiffness in adolescents. Approximately 1-2% of the population has AS.
There is a characteristic stiffening of the spine and postural changes that progress over time. Posture tends to become stopped with rounded shoulders and forward head. Rib movement may reduce, limiting capacity to take a full breath. On X-ray a ‘squaring’ of the vertebrae may be seen and as the vertebrae fuse (anklyose) a ‘bamboo spine’ is noted in the very advanced stages.
A diagnosis of AS is made based on clinical history, X-ray findings and blood tests. The diagnosis may be difficult in the early stages. A rheumatologist should be consulted to confirm the diagnosis.
The severity of AS will vary from individual to individual. Better results are achieved when efforts are made to maintain movement and posture.
Chiropractic care, flexibility exercise, postural correction, heat packs and breathing exercises may all be helpful. It is essential that individuals with AS do not smoke due the impact of restricted lung capacity.
Occasionally AS may affect non-spinal joints, such as hips, knees. It can also affect the eyes – in particular causing iritis and uveitis. Eye involvement can cause serious complications and requires specialist care from and an ophthalomologist.
Rarely heart complications may also occur.
Osteoarthritis (OA) is by far the most common type of arthritic condition with most people over 45 years showing some early signs. OA is associated with ‘wear and tear’ or ‘degeneration’ of the cartilage that form the cushion of joints. This occurs with age or trauma following injury or disease.
OA affects large weight bearing joints like the hips and knees, spine and also hands and feet. Unlike other forms of arthritis, OA does not affects organs.
There are two forms of OA:
- Not the result of injury or disease
- May have a hereditary link
- Most commonly effects hands
- Results from injury or disease. Causes include obesity, repeated injury or surgery to joints, diabetes, gout and birth (congenital) abnormalities
- Most commonly effected joints are lower neck, base of spine, hips and knees.
Diagnosis is usually on the basis of X-ray where narrowing of the joint space and bone spurs may be seen. Blood tests for OA will be negative.
OA is not always painful, and some individuals may be surprised when they see significant degenerative changes on X-rays.
An important goal of chiropractic care is to improve muscle and joint function and thereby reduce physical stress that may contribute to advancing OA. To this date there have been no clinical studies that have clearly shown Chiropractic care can reduce the progression of OA.
Mild and moderate OA is usually managed well with Chiropractic care, weight loss and exercise to keep joints mobile and well nourished. Supplements such as Glucosamine Sulphate, Chondroitin and Omega 3 fatty acids (such as those found in cold water fish – salmon, sardines, mackerel and trout) may be of benefit. So may supports, such as knee braces.
More advanced cases may require medication. Paracetamol (such as Panadol Osteo) is preferred as this has fewer side effects than Non-Steroidal Anti-Inflammatory drugs (such as Naprosyn and Voltaren) or Cox-2 Inhibitors (such as Celebrex). However, all medication has potential side effects and should be taken with caution.
In advanced cases of hip and knee OA, joint replacement surgery may be required.
Rheumatoid arthritis (RA) is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body. The immune system of an RA individual is misdirected and attacks the body’s own tissues. It is a chronic disease that most commonly effects middle-aged women and is characterised by periods of flares and remission.
The exact cause of RA is unknown though a hereditary link is suspected. Other triggers may be certain types of virus, bacteria or fungi, though this is yet to be proven. Smoking, exposure to silica and periodontal disease, have all be associated with increase risk of RA.
Typically RA causes symmetrical (both sides of the body) joint pain and swelling. During flare ups individuals may also experience fatigue, lack of appetite and fever. Any joint can be affected, but joints of the hand and wrist are most common.
Organs affected by RA may include:
- Throat – causing dryness known as Sjögren’s syndrome
- Eyes – inflammation in the whites of the eye (scleritis)
- Lungs – inflammation of the pleura causing chest pain (pleuritis)
- Heart – inflammation of the pericardium surrounding the heart (pericarditis)
The diagnosis of RA is based on physical examination, history, X-ray findings and blood tests. A rheumatologist should confirm the presence of RA.
Chiropractic care to effected joints should only be applied during the remission periods. Chiropractic care may help with improving overall wellbeing as well as with advice on nutrition and exercise.
During flare-ups it is best to reduce activity in the effected joints and use ice packs often. During remission stages it is important to be more active with exercises to improve joint function. Using ‘hand putty’ to improve wrist and hand movement is often helpful.
In more advanced cases medication may be required. Aspirin, Celebrex and cortisone are often used as short acting drugs. Methotrexate and hydroxichloroquine used as long acting drugs.
As always, if a natural approach is effective, it is always a better option. Omega 3 fatty acids (such as those in fish oil), Vit D and Quercetin (a flavenoid and antioxidant that is found in many fruits, berries, and vegetables) may be helpful.