DEAR DR. GOTT: I was recently diagnosed with ankylosing spondylitis. What causes this and what can I do to help myself? Should I be following a certain diet? Are there exercises for this to help me stay mobile?
I take meloxicam 1.5 mg. Is there another medication that would help me more?
DEAR READER: This is an inflammatory disease that can cause some of the spinal vertebrae to fuse together and go on to affect the eyes and bowels. When this occurs, the spine is less flexible and a patient takes on a hunched-forward posture. The condition affects men more frequently than it does women, with symptoms beginning in early childhood.
Early signs of ankylosing spondylitis include pain and stiffness of the lower back and hips that are exacerbated following periods of inactivity such as a night’s sleep. Those areas of the body most commonly affected include the vertebrae of the lower back, hip and shoulder joints, between the base of the spine and pelvis, and even along the back of the heel of the foot. As the disorder and inflammation progress, new bone forms and that bone gradually closes the gap between the vertebrae, fusing those sections together. The sections of the spine affected become more stiff and less flexible. This stiffening can also affect the rib cage and restrict lung capacity. Unfortunately, risk factors are out of your control and include heredity, age and sex, with men more likely to develop it than women.
Complications are unpleasant and include compression fractures, problems breathing, uveitis (eye inflammation), and heart abnormalities. On the good side, the disorder does not respond in the same manner for everyone. Instead, they vary from person to person. Problems can begin extremely slowly so things you may recognize as unusual may be attributed to other conditions. Confirmation of diagnosis may include X-rays, MRI, or CT. While some blood tests may identify inflammation, there is no specific lab testing to aid in the diagnosis.
On the home front, non-steroidal anti-inflammatory drugs such as naproxin, ibuprofen, and indomethacin are most commonly endorsed. On the downside – and there always seems to be at least one – they can reduce or relieve inflammation, stiffness and pain but they can also cause gastrointestinal bleeding. The meloxicam you are on is a prescription NSAID that reduces substances that cause inflammation and pain. You might speak with your physician to determine if another NSAID might work more effectively in your case. I cannot recommend one because I do not know if you have other medical issues that could have a bearing on what you might use. Beyond that, regular exercise and physical therapy can help maintain flexibility and should definitely be considered. It is also vital to receive regular quality sleep and to maintain good posture because if portions of the spine do fuse, it is better to have them do so with you in a good upright position. Progressing beyond that, tumor necrosis factor (TNF) blockers might be recommended. The medication is either injected under the skin or through an IV. Some examples of TNFs include Enbrel, Humira and Remicade that sadly are not without side effects. There are also medications called “disease modifying agents” such as methotrexate or sulfasalazine that may also be used as the disease progresses.
No matter almost what condition you may have been diagnosed with, eating sufficient fruits and vegetables, whole grains, fish with omega-3 fish oils and lean cuts of meat will work to your advantage. Should you be a smoker, you will be far better off quitting immediately, since the damage to your lungs can compromise your ability to breath properly.
Readers who would like related information can order my Health Report “Pulmonary Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
