ANKYLOSING SPONDYLITIS

ANKYLOSING SPONDYLITIS AND HOMOEOPATHY:

Ankylos (Greek), meaning bent. It has now come to imply something that restricts motion due to stiffening and may ultimately result in fusion. When the joint loses its mobility and becomes stiff it is said to be ankylosed. 

Spondylitis means inflammation of the vertebral bones of the spine. 

Ankylosing spondylitis (AS), previously known as Bekhterev syndrome/Marie-Strümpell disease, is a chronic progressive painful inflammatory rheumatic disease (Pseudopsora), which affects the spinal joints, in particular, the sacroiliac joints and the lumbar spine that can lead to stiffness of the back.

Inflammation of the bones in AS can lead to degeneration, pain and loss of joint motion. AS typically affects the spine but can been seen in other areas, especially the hips.

Ankylosing spondylitis (AS) is one of the many types of arthritis. 

Ankylosing spondylitis can range from a mild to more severe disease in patients. 

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 of those having it is 3:2. 

It is usually diagnosed in young adults, with a peak onset between 20 and 30 years of age. Children may also be affected by a form of AS termed “juvenile ankylosing spondylitis”, seen in children younger than 16 years of age. 

There is evidence suggesting a strong genetic component in the development of the disease.

Ankylosing spondylitis is a type of arthritis of the spine. It causes swelling between vertebrae, which are the disks that make up your spine, and in the joints between spine and pelvis. 

Ankylosing spondylitis is an autoimmune disease. This means immune system, which normally protects body from infection, attacks body’s own tissues. 

The disease is more common and more severe in men. It often runs in families.

THE EARLY SYMPTOMS:

Early symptoms include back pain and stiffness. These problems often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse vertebrae together, limiting movement.

SPINAL FEATURES

- Early physical signs include failure to demolish the lumbar lordosis on forward flexion (Psora), pain on sacroiliac compression (Psora), and restriction of movements of the lumbar spine in all directions (Pseudopsora/ Sycosis).

- Symptoms are most marked in the early morning and after inactivity and are relieved by movement (Psora). 

- As the spine becomes progressively ankylosed (Pseudopsora/ Sycosis), spinal rigidity (Sycosis) and secondary osteoporosis predispose to spinal fracture (Syphilis), presenting as acute, severe, well-localised pain (Psora). 

- Secondary spinal cord compression is a rare complication (Psora).

- The characteristic symptom of AS is sacroiliitis (Pseudopsora), the inflammation of the sacroiliac joints. 

- The pain caused by sacroiliitis is usually a dull diffuse ache (Pseudopsora), not localised, felt deep in the buttock area. 

- In starting, it may be intermittent or on one side only (Psora), or alternate between sides (Psora); however, within a few months it generally becomes persistent and is felt on both sides (Pseudopsora/ Sycosis).

BILATERAL SACROILLITIS

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

- Progressively the lower back becomes stiff and painful (Psora/Pseudopsora), with the inflammation extending to the spine. 

- With time, the back pain can gradually extends 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.

EXTRA-SPINAL FEATURE

- ‘Pleuritic’ chest pain (Pseudopsora) aggravated by breathing results from involvement of the costovertebral joints (Pseudopsora). 

- Plantar fasciitis (Psora/ Pseudopsora/ Sycosis), Achilles tendinitis (Psora/ Pseudopsora/ Sycosis) and tenderness over bony prominences (Psora) such as the iliac crest and greater trochanter result from inflammatory enthesopathy.

- Fatigue is often a major complaint (Psora/ Pseudopsora) and may result from chronic interruption of sleep due to pain (Psora/Pseudopsora) and from chronic systemic inflammation (Pseudopsora/ Sycosis).

- Extraspinal synovial joint involvement is usually asymmetrical at first and may cause inflammatory symptoms (Sycosis) 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 (Pseudopsora) may develop.

CAUSES:

• Exact cause is unknown.

• Evidence points to autoimmune etiology.

• Positive family history.

SYMPTOMS:

• Onset: insidious.

• Pain in back, buttocks.

• Morning stiffness, better with activity.

• Weight loss.

• Fatigue.

• No movement possible.

Gradual involvement of:

1. Whole vertebral column.

2. Hips.

SIGNS:

• Tenderness at sacro-iliac joint.

• Cervical, thoracic spines become tender.

• Restricted movement.

• Patient cannot erect spine.

• Sits, walks with flexed spine.

• Chest expansion diminished.

• Complete rigidity of spine & involved joints.

• Kyphosis (curve in spine).

PATHO-PHYSIOLOGY:

Entheso-pathy:

- The inflammation in AS tends to start at the places where joint capsules, ligaments or tendons are attached to the bone, resulting in pain or tenderness at these sites (Psora).

- 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 (Psora/ Syphilis).

- This process may, after many years, lead ultimately to complete spinal fusion (Pseudopsora).

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 (Sycosis), called as sclerosis (Sycosis) of these corners. 

- The bone at these corners may subsequently disappear (Syphilis), and this may ultimately result in squaring of the vertebral bodies (Pseudopsora).

Syndesmophyte:

- Gradually a thin layer of vertical bony outgrowths at the edges of the vertebrae bridges the gap (Sycosis) 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 (Psora/ Sycosis) and slowly progressive bony fusion (Pseudopsora) 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 (Pseudopsora) called as bony ankylosis (Pseudopsora) of the whole spine. 

- The X-ray of the spine may ultimately look like a bamboo and is sometimes called bamboo spine (Pseudopsora/ Sycosis).

Bamboo spine: 

Frontal radiograph shows a complete fusion of the vertebral bodies. Extensive facet joint ankylosis and posterior ligamentous ossification produce the trolley track appearance. Vertebral body squaring.

IN PICTURE YOU CAN SEE BAMBOO SPINE, LADY IS STRAIGHT IN ARM, NOT A 1% SHE BENT BETWEEN TWO ARMS.

Spinal osteoporosis:

- Spinal osteoporosis (Syphilis/ Psora) is also frequently observed among such patients, partly as a result of the lack of spinal mobility and ageing.

Chest involvement:

- The inflammation of the costovertebral and costotransverse joints (Pseudopsora), and at the costochondral areas, can result in chest pain and tenderness. 

- This pain can be aggravated by coughing or sneezing. Gradually in chest expansion may be decreased Psora/ Pseudopsora).

COMPLICATIONS:

- Osteoporosis

- Spinal fracture

- Quadriplegia

- Spondylodiscitis

- Spontaneous subluxation of the atlantoaxial joint

- Cauda equina syndrome

- Glomerulo-nephritis

- Acute iritis/ uveitis

- Conjunctivitis

- Depigmentation and scarring of iris

- Cardiomegaly

- Pericarditis

- Aortic incompetence

- Mitral incompetence

- Cardiac conduction defects

- Amyloidosis

- Apical pulmonary fibrosis with cavitation

- Prostatitis

Tests for Ankylosing Spondylitis Diagnosis

Blood

• Hb% : low.

• ESR: raised.

• HLA-B-27: positive.

• CRP: raised.

• Rheumatoid factor: negative.

• ANA: negative.

X-Ray sacro-iliac joints

Early

• Narrowing of joint space.

• Haziness of joint margins.

• Marginal erosions.

• Marginal sclerosis.

Late

• New bone formation.

• Bridging of joint cavity.

X-Ray vertebral column

• Ossification of spinal, para-spinal ligaments.

• Squaring of vertebrae.

• Ossification of intervertebral discs.

• Bamboo spine (fusion of entire vertebral column).

Homoeopathic Treatment For Ankylosing Spondylitis:

- Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition.

- The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc.

- A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions.

- In this disorder too, the homoeopathic medicines work by optimising the body’s overactive immune (defense) system.

The stage of the disease at which the homeopathic treatment is started, is a major factor in determining the outcome of the treatment. For example if the treatment is started in the initial stages when not too much of the elastic tissue is lost, the prognosis are very good and the condition can be reversed in most of the cases .In stages where extensive bone formation has replaced elastic tissue, homeopathic medicines may not be able to reverse the situation but can still help in easing many symptoms.

- The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition.

Homoeopathic Remedies For Ankylosing Spondylitis:

Belladona:

- Pain in nape, as if it would break.

- Stiffness and painful swelling in neck and nape of neck.

- Darting, as if from knives in the bones of the spine.

- Shooting pains along limbs.

- Neuralgic pains that come and go suddenly.

- Cold extremities.

- Especially right sided.

- Throbbing, burning, stabbing pains.

- Pain worses with jar, draft of air, noise, touch, cold application, lying on affected side

- Pain ameliorates with warmth, lying part on something.

Cimicifuga Racemosa

- Cimicifuga is the best homeopathic medicine for ankylosing spondylitis when there is marked stiffness in neck area.

- Excessive stiffness in neck with severe pain.

- Neck muscles feel retracted.

- Neck stiffness is worsened in cold air, motion, night and morning.

- Affects belly muscles, esp. large muscles.

- Pains come on suddenly.

- Pain like electric shocks here and there.

- Sharp lancinating.

- Rheumatic pains in muscles of neck and back ; a feeling of stiffness and retraction.

- Lumbosacral pains extending down hips and thighs are also present

Kalmia:

- Pain & stiffness are attended with heat, numbness or prickling sensation.

- In cases where pain & stiffness are marked in lower back and neck area.

- Pain, lameness, stiffness in lumbosacral area.

- Pain neuralgic especially right side with numbness.

- Muscles of neck sore to touch and on moving them.

- The pains are accompanied with heat & burning in affected area.

- Numbness and pricking sensation may appear at painful site. In addition to this neck pain and stiffness are marked.

The neck region is sore and tender to touch.

- The pain from neck often radiates down the arm or in the scapula.

- The pain usually appears in paroxysms. The pains are worse in the early part of night.

- Pain ameliorated by food.

Kali Carb:

- Kali Carb is a valuable remedy to use when back feels extremely weak with pain and stiffness.

- Feeling of paralytic weakness in back and must lie down.

- While walking back gives out and the patient has to sit down.

- The back is very painful and stiff and feels as if it was broken. The pain from lower back may extend down the thighs or ascend to upper back.

- Sharp, stitching, stabbing or catching pains.

- Throbbing pains ; numbness or coldness of parts.

- Paralytic feeling.

- Changing position while lying aggravates the back pain and the sufferer must rise in order to change the position in bed.

- Sharp, stitching pains in back shoot into gluteal region or hips.

- Morning aggravation of lumbosacral pain around 3:00 am may be seen.

- Pain aggravates after draft of cold air, after overheating, after exertion, touch.

- Pain ameliorated by warmth, during day, open air, motion.

Aesculus:

- The main indicating feature for its use is marked pain in lumbosacral area of the back and hips with extreme stiffness. 

- Pain from the back may radiates to thighs.

- Pain may be of aching, sore, tearing nature or it is can be severe that it may give sensation of a broken back.

- Rising from seat, walking and stooping are all difficult and painful.

- The patient has to make repeated efforts to rise from seat.

Severe pains and stiffness in lumbosacral region make it impossible to walk.

- Pain in sacroiliac region and back appears and person feels as if legs & back would give out when walking. 

- Back is extremely rigid, stiff, weak and painful.

Rhus Tox:

- Pains & stiffness are worse at rest.

- In ankylosing spondylitis it is applicable when pain and stiffness in back and hips is worse when person is at rest.

- Pains are aggravated after a period of inactivity.

- Walking helps to relieve the backache and hip pain.

- Rheumatic pain with stiffness.

- Pain tearing in tendons, ligaments and fasciae with rigidity and paralytic weakness of the joints.

- There is marked stiffness, lameness and pain in lumbosacral area of back and hips.

- The pain goes down from back and hips to thighs.

- Loss of power in forearm and fingers.

- Crawling sensation in the tips of fingers.

- Tongue dry or dark coated with red triangular tip.

- Restlessness.

- Sitting aggravates the pains.

- Hard pressure and lying on something hard seems helpful in providing relief in the pains.

- Rest, damp weather, walking after rest worsens the pain and continue motion relieves.

Phosphorus:

- Rigidity of nape of neck. Pressure on shoulders.

- Swelling of neck.

- Paralysed sensation in upper sacrum and lower lumbar vertebrae.

- Contusive pain in loins and back (as if back were broken), especially after having been seated a long time, hindering walking, rising up, or making the least movement.

- Pain in small of the back when rising from a stooping position.

- Sensitiveness of spinous processes of dorsal vertebrae to pressure.

- Softening of spine.

- Heat or burning in back, between scapula.

- Tearings and stitches in and beneath both scapula.

- Pain in coccyx impeding easy motion, can find no comfortable position, followed by painful stiffness of nape.

- Coccyx painful to touch as from an ulcer.

- Transient pain from coccyx though spine to vertex that drew head back during the stool. Backache and palpitations prevail.

- Phos best adapted to tall slender persons of sanguine temperament, fair skin, eyelashes, fine blond, or red hair, quick perceptions, and very sensitive nature. Young people who grow too rapidly are inclined to stoop who are chlorotic or anaemic; old people, with morning diarrhea.

- Nervous, weak; desires to be magnetized.

- Oversensitiveness of all the senses to external impressions, light, noise, odors, touch.

Calc carb:

- Pain as if sprained; can scarcely rise; from over-lifting.

- Pain between shoulder-blades, impeding breathing.

- Rheumatism in lumbar region; weakness in small of back.

- Curvature of dorsal vertebrae.

- Nape of neck stiff and rigid.

- Pains, as of dislocation in neck and back as if caused by a strain in lifting a weight.

- Pain worsens in early morning, after exertion, cold in every form, wet weather.

- Weakness and trembling of limbs.

- Frequent paralytic weakness in the fingers.

- Cannot sit upright in chair from weakness of back.

- Vertebrae, feel loose; painful on pressure.

- Calc carb suits to person with Leucophlegmatic constitution, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth.

- Psoric constitutions; pale, weak, timid, easily tired when walking.

- Disposed to grow fat, corpulent, unwieldy.

- Bones soft, develop very slowly.

- Curvature of bones, especially spine and long bones; extremities crooked, deformed; bones irregularly developed.

- Head sweats profusely while sleeping.

Calc Phos:

- Rheumatic pain and stiffness of neck with dullness of head, from slight drought of air.

- Cramp-like pain in neck first one side then the other (right to left).

- Throbbing or jerking pains below scapula.

- Violent pain in region of back when making the least effort.

- Backache and uterine pains.

- Sharp pains in sacrum and coccyx.

- Soreness as if separate in sacro-illiac synchondrosis.

- Curvature of the spine to the left, lumbar vertebrae bend to the left, spina bifida.

- Soreness in sacro-iliac symphysis, as if broken.

- Calc phos suits to person with anaemic and dark complexion, dark hair and eyes; thin spare subjects, instead of fat.

GUAICUM 30:

- When there is severe pain in the neck along with rigidity.

- Pain from head to neck.

- Aching in nape.

- Stiff neck and sore shoulders.

- Stitches between the scapulae to occiput.

- One sided stiffness of back from neck to sacrum.

- There are contractive pain between scapulae.

- Stiffness from neck may also extends to shoulders.

- Shoulder blades are also painful.

Lachnanthus:

- Stiffness of neck, head being twisted on one side especially right.

- Stiffness and pain in the neck.

- Sensation of spraining in neck.

- Extending over whole head down to the nose with sensation as if nostrils pinched together.

- Pain worses by turning head backward.

Phos Acid:

- Tension and cramp-like drawing in muscles of neck, especially on moving head.

- Miliaria on neck.

- Boring pain between scapulae.

- Spondylitis of cervical vertebrae.

- Burning pain in a spot above small of back.

- Itching stitch in coccyx, fine stitches in coccyx and sternum.

- Crawling (formication) tingling in back and loins.

- Phos acid best suited to persons of originally strong constitutions, who have become debilitated by loss of vital fluids.

Silicea:

- Stiffness of nape, with headache.

- Caries of clavicle.

- Stitches between the hips.

- Stiffness of nape with headache

- Griping pains with a tearing away feeling, of twisting or as of something being torn away.

- Jerking pains

- Drawings and tearing in arms, hands and fingers.

- Coccyx painful, as after a long carriage ride.

- Stinging in os coccyges on rising, painful to pressure.

- Pain in the loins, which prevents rising up, and forces patient to remain lying down.

- Inflammatory abscess in lumbar region (on the psoas muscle).

- Weakness and paralytic stiffness in back, loins and nape.

- Tearings and shootings in the back.

- Swelling and distortion of spine (curvature of the vertebrae).

- Contusive pain between the shoulder-blades.

- Pain aggravates in nigh, during full moon, in evening, change of weather, movement, touch, cold air.

- Pain ameliorates in summer, heat, wet weather, in warm room.

Sulphur:

- Stiffness of neck, in nape with paralytic sprained pain.

- Cracking in vertebrae of neck especially on bending forwards.

- Sharp and rheumatic pains, drawing, tension and stiffness in nape.

- Tension and burning pain between scapula and in nape which on moving head goes to shoulders.

- Cracking in vertebrae of neck, especially on bending backwards.

- Weakness and wrenching pains, or pain as from a bruise in loins, coccyx, and in back, especially on walking, or rising from a seat.

- Gnawing pain in small of back. Pain in small of back not permitting one to stand erect. Finds himself at night lying on back.

- Cannot lie on back on account of rush of blood to head.

- Pain in back after manual labour.

- Shootings in loins, back, and shoulder-blades, sometimes with obstructed respiration.

- Sharp and rheumatic pains, drawing, tension, and stiffness in loins, back and nape.

- Pinching and burning sensation between the shoulder-blades.

- Tension and bruised pain between scapulae and in nape, which on moving head goes to shoulders.

- Stitches beneath scapulae which take away the breath.

- Drawing in right scapula, evening on going to sleep.

- Tearing in left scapula while sitting. Needle-shoots at point of left scapula. Sprained pains in back.

- Sensation of burning.

- Congestions to single parts.

- Aversion to be washed.

- Sensation as if muscles of neck and back were too short.

- Pain aggravates periodically, night and evening, warmth of bed, draft of air.

- Pain ameliorates in warm room

Causticum:

- Stiffness and tension in nape of neck.

- Pain, as from a bruise in the nape of the neck.

- Acute and violent pulling in the joints and bones, mitigated by heat of bed.

- Stiffness of neck, on rising from a chair.

- Stiff neck, can scarely move the head.

- Pain aggravates by motion, washing, bathing, in evening, in open air, motion of carriage, stooping, damp weather.

- Pain ameliorates by heat of bed, warm room, every change of weather.

Please do not take any medicine on least symptoms matching, homoeopathic medicine must be taken after case taking by homoeopathic doctor.

For any help- 

Contact:

Dr. Mayur Modi

+919510404646

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