Ayurvedic Treatment for Ankylosing Spondylitis works in different levels of the disease. The primary aim to arrest the progression of the disease, then rejuvenate the joints and corrects the basic metabolism of the body to prevent the further accumulation of toxins. Ankylosing spondylitis is a type of inflammatory arthritis affecting the spine and large joints. This is a seronegative spondyloarthropathy. Male are prone to this condition and it usually begins in early adulthood. This condition is also known as Bechterew disease. Usually, the disease starts from the lower back and spreads to the neck and other joints.
- Signs and symptoms of Ankylosing spondylitis
- Causes of Ankylosing spondylitis
- Diagnosis of Ankylosing spondylitis
- Treatments of Ankylosing spondylitis
- Complications of Ankylosing spondylitis
- Ankylosing spondylitis in Ayurveda
- Nidana- Causes of Ankylosing spondylitis
- Samprapthi (Maturation) of Ankylosing spondylitis
- Lakshana of Ankylosing spondylitis
- Chikitsa (Treatment) of Ankylosing spondylitis
- Commonly used medicines
- Home remedies and Diet
- Yoga
Signs and Symptoms
As the name says Ankylosis means fused bones and spondylitis means inflammation of vertebral bones and spine. Though it usually starts from the Sacroiliac joint it affects other joints also. The symptoms include,
- Pain and stiffness in the lower back, buttocks, shoulder, rib cage, hips, etc.
- Pain gets worse in the morning and after long sitting
- Tiredness and difficulty in taking a breath
- A rigid spine which is curved forward
- Swelling of joints
Causes
Several factors are involved in the occurrence of Ankylosing spondylitis. People who have a gene called HLA-B27 are at a greatly increased risk of developing ankylosing spondylitis. Only some people with this gene develop the disease. Some environmental factors also trigger the condition but they are not exactly known.
Pathophysiology
The pathology of Ankylosing spondylitis mainly affects sites, where ligaments, tendons, and capsules are attached to the bone known as entheses. Three processes are observed at the entheses during the maturation of disease: inflammation, bone erosion, and syndesmophyte (spur) formation. In the inflammatory process tumour necrosis factor is an important mediator. But this proinflammatory cytokine is not closely involved in bone erosion or syndesmophyte formation.
The exact pathophysiology is still incomplete and many hypotheses regarding this are available.
Diagnosis
The history and symptoms and the physical examination to test the range of movements of the spine can guide the diagnosis.
X-ray shows visible signs of Ankylosing spondylitis. X-ray findings include the altered shape of bones, and joints that are thickened, fused. Spur formation is also seen in the bones. MRI can be used to diagnose the early disease process.
No specific test for Ankylosing spondylitis but inflammatory markers will be elevated. Blood can be tested for the HLA-B27 gene. But all persons with this gene won’t develop the disease.
Treatments
Treatment aims to reduce the pain and stiffness along with delaying complications and spinal deformity.
Medications include are used to reduce inflammation and pain. This includes NSAIDs like naproxen, indomethacin. A tumour necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor is also used if NSAIDs do not work. TNF blockers target a cell protein that causes inflammation in the body. IL-17 plays a role in the body’s defence against infection and also has a role in inflammation.
Physiotherapy treatments are advised to reduce stiffness and increase flexibility. Posture maintenance is an important goal in the treatment of Ankylosing spondylitis.
If bone or joint is severely damaged then surgery is advised.
Prognosis
The patients need long-term anti-inflammatory treatment along with physiotherapy. The symptoms vary from person to person and proper treatment can delay the progression and spinal deformities. But the complete cure is very difficult.
Complications
The complications due to the Ankylosing spondylitis can affect the day to day activities of the patients and it includes,
- Reduced flexibility of joints and joint damage
- Iritis or uveitis in which the front part of the eyes becomes swollen.
- Osteoporosis and spinal fractures.
- There is a risk of developing cardiovascular diseases.
Disease and Ayurveda
In Ayurveda, Ankylosing spondylitis comes under the purview of Vata vyadhi. Symptomatically this can be said as Danta apatanaka.
Nidana- Causes
No specific nidana is said by Acharyas, but the etiological factors responsible for vitiation of vata dosha can also cause this condition.
- Light, dry and cold food, less intake of food
- Night awakening, overindulgence in the sexual act
- Excessive bleeding causes dhatu kshaya (depletion of tissues)
- Long-standing diseases
- Accident or trauma
Samprapthi Maturation
The vitiation of vata dosha along with kapha which in turn gets lodged in dhamani causing stiffness similar to a stick. Sthana samsraya of vitiated doshas occur in Asthi (bone) and majja dhatu.
Lakshana Signs and Symptoms
The symptoms get manifested includes,
Stiffness of back from hip to neck
Restricted forward and sideward bending
Pain in the right upper limb with restricted
movements
Pricking pain and swelling over the nape of the neck
Swelling over right shoulder and right side of the face
Stiffness of back from hip to neck
Restricted forward and sideward bending
Pain in the right upper limb with restricted
movements
Pricking pain and swelling over nape of the neck
Swelling over right shoulder and right side of face
- Stiffness of back from neck to hip
- Restricted movements
- Pain and restricted movements of upper limb
- Pricking pain and swelling in the neck, face.
Prognosis
This is considered difficult to treat and if the patient is weak it will endanger life.
Chikitsa- Treatment
Snehana (oleation), swedana (sudation) and mridu virechana (mild purgation) can be chosen as the treatment modality.
Ksheera vasthi can be done using drugs possessing a bitter taste.
Virechana can be done using medicated castor oil
For snehapana Dhanwantharam ghrita can be used.
Greeva vasthi and kadee vasthi can be done to reduce the stiffness of the neck and lumbosacral joints.
Commonly used medicines
- Dhanadanayanadi kashaya
- Maharasnadi kashaya
- Dhanwantharam kashayam
- Dhanwantharam thailam, narayana thailam, prasaranyadi thailam, etc. for external application
- Sudation using pottali made of medicated leaves
- Yogaraja guggulu
- Trayodasanga guggulu
- Nasal instillation of Anu thaila, Ksheera bala thaila
- Ras raj Ras
- Yogendra Ras
- Vrihat Vat Chintamani Ras
- Rasamanikyam
Brands available
- Aryavaidyasala Kottakkal
- Vaidyaratnam Oushadasala
- SNA
- Dhootpapaeswar
Home Remedies
The remedies which can be done at home to reduce the symptoms include,
- Stretching of the lower back and spine to reduce the stiffness.
- Application of heat to reduce the pain and stiffness
- Cold therapy in the case of swelling
- Gentle massage and mild exercises
Diet
- The ideal food items include Omega 3 fatty acid-rich food, fruits, vegetables, whole grains, and beans.
- Avoid alcohol, reduce intake of sugar, high-fat food items
Yoga
The yoga postures which can reduce pain and stiffness includes,
- Setubandhasana
- Sisu asana
- Bhujangasana
- Parvatasana
- Marjarasana
- Gomukhasana
Research articles link.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910574/