Q: Dear Doctor,Few months back I had indicated few tell-tale symptoms that have affected my movements. Since then I have been diagnosed to suffer from Ankolysing Spondilitis with HLA-B27 positive. All the indications seem to confirm the diagnosis. Please let me know the lines of treatment, conventional and unconventional both, to allow a reasonable quality of life with the disease which seems to be a perpetual companion now. I am only 32 years now and is it too much to expect a near-normal life?
A:Ankylosing spondylitis is a type of arthritis, or a rheumatic disease. It affects the spine, causing the joints to become stiff and swollen. People who suffer from ankylosing spondylitis experience back pain and stiffness, and sometimes significant loss of motion as the bones fuse together. Like other types of arthritis, ankylosing spondylitis is a chronic condition for which there is no known cure. However, this does not mean that once diagnosed you are confined to a life of pain. Despite the lack of a cure, there are many treatments that can lessen your symptoms and help you to lead an active life with less pain. It is very important that a positive attitude and patience is maintained throughout the treatment plan. The treatment focuses on reducing the pain and stiffness in the back, and on trying to prevent any further spinal deformity. The treatment plan is adjusted to particular symptoms and their severity. Conservative treatments with medication and rehabilitation therapies are explored first, but surgery may become necessary if bones in the spine fuse and significantly impair movement. Drugs such as NSAIDs (Non Steroidal Anti-Inflammatory Drugs) may be used to reduce pain and inflammation, and these include ibuprofen and indomethacin. In severe cases of ankylosing spondylitis, a drug known as phenylbutazone may be highly effective, but the side effects may be more severe as well. Your doctor will prescribe these medications. It is very important for you to check with your doctor before taking any over-the-counter medications, as they could be very similar to the prescription medications you are taking. Your doctor may also refer you to a specialist known as a rheumatologist who is a doctor who has additional training and specialization in treating arthritis and related diseases. It is also very important to make some adjustments to your daily schedule that can greatly improve your standard of living. One of these is to maintain a good posture. This is important because if your joints do ultimately fuse, you do not want them to fuse in an awkward position. It is important to maintain good position during sleep as well as when sitting or walking. Another is to maintain an exercise program. Exercise is not only helpful in maintaining good health and fitness, but can also help to slow the progression of your disease. Your doctor or physical therapist can help you to determine what exercises can be done without aggravating your symptoms. You should quit if you are a smoker. In addition to being bad for your health in general, it is particularly harmful for patients with ankylosing spondylitis. This is because the condition can affect the rib cage and make breathing more difficult, and care should be taken not to compromise the lungs. In very severe cases, surgery may be required to either replace the affected joint or straighten fused bones. However, surgery is not generally necessary in patients with ankylosing spondylitis.