Using this weird “jelly” discovered in a tiny remote Japanese village.
Ankylosing spondylitis is an inflammatory condition that mainly affects the spine, that causes progressive stiffness and pain. It’s part of the seronegative spondyloarthropathy group of conditions that are related to the HLA B 27 gene. And other conditions in this group are things like reactive arthritis and psoriatic arthritis. The key joints that are affected in anklosing spondylitis are the sacro iliac joints and the joints of the vertebral column.
And the inflammation causes pain and stiffness in these joints, and it can progress to fusion of the joints. So fusion of the spinal column and the sacraliac joints fusion of the spine leads to the classical finding on the x ray of a bamboo spine. And this is something that will often appear in your medical exams. There’s a strong link with the HLA B 27 gene, and around 90% of patients who have ankylosing spondylitis will have this HLAB 27 gene.
However, only around 2% of people who have the gene will develop ankylosing spondylitis. This number goes up to around 20% if they have a first degree relative that’s affected. So if you have a first degree relative and the HlAB 27 gene, there’s around a 20% chance of developing the condition. So how do these patients present the typical presentation, especially in your exams, is a young adult male in their late teens, or affects males about three times more often than females, and symptoms usually develop gradually over more than three months.
The main presenting features are low back pain and stiffness and sacroileac pain, which occurs in the buttock region. The pain and stiffness is worse with rest and it improves with movement. And the pain is worse at night and in the morning, and it may even wake them up from sleep in the early hours of the morning. And when you take a history, the patient will describe how it takes at least 30 minutes for the stiffness to improve in the morning, and then that stiffness seems to get progressively better throughout the day as they do more and more activities.
The symptoms can fluctuate with periods of flares of worsening symptoms and other periods where the symptoms seem to improve. One of the key complications of anklosing spondylitis is vertebral fractures. So what associations are there between ankylosing spondylitis and other affected areas in the body? An ankylosing spondylitis doesn’t just affect the spine, it can affect other organ systems and cause things like systemic symptoms such as weight loss and fatigue. It can present with chest pain related to the costovertebral joints and the costosternal joints.
Enthusitis is inflammation of the enthuses, and this is where the tendons or the ligaments insert into the bone. This can cause problems like plantar fasciitis and achilles tendonitis. Dactylitis is a condition where there’s inflammation of an entire finger or toe. It can cause anemia, anterior uvitis, aortitis, which is inflammation of the aorta or the large blood vessel coming out of the heart. It can cause heart block when there’s fibrosis of the heart’s conduction system.
Restrictive lung disease can be caused by restricted movement in the chest wall, and ankylosing spondylitis can also be associated with pulmonary fibrosis, particularly at the upper lobes of the lungs, and this occurs in about 1% of patients. Another condition that’s also associated with ankylosing spondylitis is inflammatory bowel disease. There’s a test called Shoba’s test, which you’re expected to know about in medical school, and this is a test that’s used as part of a general examination of the spine to assess how much mobility there is, particularly in the lumbar spine.
You might be asked to do this in your OSCi examinations. So how do you do it? Well, you have the patient stand straight. You find approximately where their l five vertebra is, and then you mark a point 10 cm above the l five vertebra and 5 cm below, so the points are 15 cm apart. Then you ask the patient to bend forward as far as they can, and you measure the distance between the two points. If the distance between them when they’re bending forwards is less than 20, indicates there’s a restriction in the lumbar movement, and it would help to support a diagnosis of ankylosing spondylitis.
What investigations can you do? Well, you can start with some basic inflammatory markers like CRP and ESR. They might go up with increased disease activity. You can send off a genetic test to look for the hlab 27 gene. You can do x rays of the spine and the sacrum. And if the x rays are normal, an MRI of the spine can show early changes and this shows up as bone marrow edema in the vertebral bodies. And this is something that will appear before there’s any changes on the x ray.
So what x ray changes do you get? Well, this bamboo spine is the typical exam description of the x ray appearance of the spine in later stages of anklosing spondylitis. And it’s worth remembering this term in case it appears in your MCQ exams. Xray images and anklosing spondylitis can show squaring of the vertebral bodies. Subcondrial sclerosis and subcondrial erosions. Syndesmophytes, which are areas of bone growth where the ligament normally inserts into the bone. And this occurs relating to the ligaments that support the intervertebral joints.
So where the ligaments insert into the vertebra to hold the vertebra together, you can get these developments of bony growth called syndesmophytes. Ossification can occur in the ligaments, the discs and the joints, and this is where the structures like the ligaments starts to turn into bone like tissue. And you can get fusion of the facet joints, the sacro iliac joints and the costovertebral joints. So there’s no longer any movement at all in those joints.
So let’s move on to the management of anklosing spondylitis. Let’s first start with the medical management of the condition. So the first step would be nonsteroidal antiinflammatory medication like ibuprofen or naproxin, and these can be used to help with the pain related to the inflammation. If the improvement in the pain and the symptoms aren’t adequate after two to four weeks of a maximum dose, then you can consider switching to another nonsteroidal antiinflammatory and simply switching medication can sometimes lead to an improvement in symptoms.
Steroids can be used during flares of the condition to help control the symptoms and this could be oral steroids or intramuscular slow release injections or steroid injections directly into the affected joints. The next step is medications that target tumor necrosis factor and anti tnF. Medications like a tannicept or monoclonal antibodies against TNF such as infleximab, adelinumab and sertilizumab are known to be effective in treating the disease activity and anklosing spondylitis if these don’t work.
So if you get no adequate response from NSAIDs, steroids and TNF inhibitors, then there’s a monoclonal antibody against interleukin seven called secokinumab. And this is a relatively new medication that shows promising results in anklosing spondylitis. Then you need to move on to additional to support the medical management. Physiotherapy is really important to give them exercise and encourage them to mobilize their spine to keep that flexibility and mobilization there. Avoiding smoking is important. Bisphosphonets can be used to treat.
about ankylosing spondylitis, including risk factors, pathogenesis, signs and symptoms, and how we diagnose and how we treat ankylosing spondylitis. So what is ankylosing spondylitis? If we were to look at the words in more detail? Ankylosing refers to stiffening or fusion. That’s what ankylosing means. If we were to break the word spondylitis down the prefix spondyl means spine and itis means inflammation. So ankylosing spondylitis is essentially a fusion of the spine due to inflammation.
But more specifically, ankylosing spondylitis is a chronic seronegative inflammatory spondyloarthropathy. So a lot of words there. So it’s chronic because it’s long lasting condition, it’s seronegative because if we look at blood work, rheumatoid factor is negative and it’s inflammatory because this is an inflammatory condition involving inflammation of the joints. And spondyloarthropathy is, again, spondyl means spine, arthropathy means disease of the joint.
So that’s what all that means. And anklosing spondylitis is a type of axial spondyloarthritis. Now, interestingly, anklosing spondylitis is more common in men compared to women. The ratio of men to women is actually three to one. So this is a more common condition in males, and it has an onset in early adulthood. Typically by the age of late teens to early twenty s, it can be anywhere from 15 to 45. What’s key to know about anklosing spondylitis is that the majority of cases of anklosing spondylitis are HLA B 27 positive.
So if we look at a patient with anklosing spondylitis and we check their HLA B 27 status, they’re more likely to be positive. And this can be anywhere from cases have this positive blood finding. And this all ties in with family history as well, since this is a family trait. So the epidemiology of anklosing spondylitis can be remembered by what we call the rule of twos. 0.2% of the general population has ankylosing spondylitis, so it’s a rarer condition. 2% of HLA B 27 positive individuals will have ankylosing spondylitis.
So in the general population, depending on ethnicity, there’s probably about eight to 10% of the general population is hlab 27 positive. Only 2% of those individuals will have ankylosing spondylitis. So having HLA B 27 positive doesn’t necessarily mean that you are going to get ankylosing spondylitis. But majority of ankylosing spondylitis patients are HLA B 27 positive. And the other part of the rule of Twos is that 20% of hlab 27 positive individuals with an affected family member will have ankylosing spondylitis themselves.
So it seems to be related to hlab 27 but also having a family history. All of this seems to tie together with your increased risk of getting this condition. So what is the pathogenesis of ankylosing spondylitis? So as we mentioned before, there’s genetic causes, but there’s also non genetic risk factors as well. And this all ties together with gut microbiome alterations. Very interesting. So when these two combine together, they lead to the activation of lymphoid cells.
And these lymphoid cells can migrate to the axial skeleton and sometimes into peripheral joints as well. So these are innate lymphoid cells that produce interleukin 17 and intralukin 22. So these are cytokines that can lead to a variety of effects causing inflammation in the joints. The intralukins along with tumor necrosis factor alpha or TNF alpha are connected and they can lead to inflammation in the joint as well.
There’s also some interaction with cycloxygenase enzyme or Cox enzyme. And what’s important with all of this inflammatory response is mechanical stress. So mechanical stress on the joints, particularly in the spine and some peripheral joints, can lead to inflammation in those joints anyways. And then with all of this proinflammatory response due to these migrated lymphoid cells, it gets worse and we get this pathological response being heightened and causing damage. So you might be wondering, where does HLA B 27 play a role in all of this? Well, HLA B 27, or human leukocyte antigen B 27 plays a role in this pathogenic process through its effects on altering the gut microbiome.
So this is where it seems that HLA B 27 is involved. It leads to alterations in gut microbiome that are necessary for the genetic and non genetic risk factors to all come together and activate these lymphoid cells. So with all of that inflammation in the spine and other joints, we go from having healthy vertebrae to inflamed vertebrae and eventually if the inflammation is not dealt with appropriately, we start to see progressive fusion of bones and we start to see loss of the cartilage in between the vertebrae.
What are some of the clinical features of anklosing spondylitis? So the axial skeleton involving the spine is the most commonly affected. Particularly the most prominent symptom patients will have is going to be mid low back pain. And the mid low back pain is not like a lot of mechanical lower back pain that many patients will present with. It is inflammatory in nature. What does that mean? Well, they’re more likely to have prolonged morning stiffness.
So in the morning when they first wake up and they try to get going, their back’s extremely stiff. And this prolonged morning stiffness is greater than 1 hour. Mechanical lower back pain might have morning stiffness, but it’s usually less than 30 minutes. So if it’s prolonged morning stiffness of greater than 1 hour, it’s more likely to be inflammatory in nature. Another key component of an inflammatory lower back pain is pain at night.
So if pain gets worse and worse at night, it could be indicating that this pain is inflammatory. And what’s also important to note about this mid lower back pain and ankylosing spondylitis and inflammatory pain in general is that it gets better with activity. So at first, when you first start getting started, there’s a lot of stiffness, there can be gelling. So stiffness, when you rest for a while and then while you get moving, that pain and that stiffness gets better.
And that’s actually a key component of inflammatory pain. Whereas noninflammatory pain, like other types of arthritis, like osteoarthritis, usually gets worse with activity. So this is a key defining or distinguishing feature of this type of pain. We may also see sacroilitis, so pain of the sacro iliac joint, or inflammation of the sacro iliac joint. This presents as buttock pain, so pain in the bum and that pain can alternate. It can go from one side to the other, or it can be present in both sides.
We can also see neck pain. So this affects the entire spine, including the neck. And actually the neck pain can be one of the first presenting features of this condition. And because of that prolonged inflammation and the fusion of the bones, patients with this condition can begin to see decreased spinal mobility. They have a difficult time bending and flexing their spine. Now, although the axial spine is the most commonly affected, the lower extremities can also be affected with regards to the peripheral arthritis we talked about earlier.
So the most common joints that are affected, besides the spine and the vertebrae, are ankles, hips and knees. So with this condition, we can see arthritis of the ankles, hips and knees as well. We can see enthusitis. So, enthusitis is an inflammation of where the tendon inserts into the bone. And typically, with regards to this finding, we see heel pain. So pain of the Achilles tendon, where it inserts into the calcaneous. And we can also see dactylitis.
So inflammation of the toes can be found as well. So because of all these features, we can have certain complications, and some of these include kyphosis. So what is kyphosis? So, in a normal spine, we have normal curvature of the spine. There is cervical lordosis, thoracic kyphosis and lumbar lordosis. But with regards to kyphosis, we get an increased curvature of the thoracic.Of the thoracic spine.
So there’s an increased thoracic kyphosis, which can cause a lot of issues with the posturing of an individual, so their posture can be affected. If we were to do an occiput to wall test, so we basically get them to push all the way against the wall, there’s a huge distance between their occiput and the wall, whereas in a normal individual, it should align with the back, so we wouldn’t have that huge distance. Other complications include spinal stenosis.
So because of all of that inflammation in that fusion of bone, the vertebrae in the spine can become fused and enlarged and have syndesmosis form, which can impinge on the spine itself, leading to spinal stenosis. And another complication is secondary osteoporosis. Because of all that inflammation and some of that remodeling we talk about, we can lose some of our bone density, so the bones can be more parotic or have osteoporosis. So if we look at a normal bone here compared to osteoporosis, we can see the pores are enlarged in osteoporosis, what are some other findings?
So these are more due to the inflammatory nature of the ankylosing spondylitis. There are extraarticular manifestations with this condition. One of them is acute anterior uvitis. So the uVa is actually one of the layers in the eye, and this becomes inflamed with this condition. Another eye finding is scleritis. So it’s not like uvitis, where we have inflammation even over the pupil and the iris. We only see it on the sclera of the eye, but you can see very reddened and erythemidous areas, that is scleritis.
So inflammation of the sclera of the eyes. We can also see aortic regurgitation, which can be a relatively severe manifestation of this condition because it can lead to structural heart change if not dealt with appropriately. We can also see apical interstitial lung disease, another severe manifestation. We can also see iga or immunoglobulin a nephropathy with this condition. So the kidneys can be affected, and we can see inflammatory bowel disease with this condition as well.
And we can see dermatological findings like psoriasis as well. So ankylosing spinylitis not only affects the spine and peripheral joints, but it can affect many other parts of the body as well, due to its systemic inflammatory actions. These parts of the body can include the eyes, the aorta of the heart, the lungs, the kidneys, the gastrointestinal system, and even the skin as well. In the form of psoriasis, there are important radiological features in ankylosing spondylitis.
So if we were to take a look in an x ray and we look at the si joint or the sacro iliac joint, we can see something termed pseudo widening. Pseudo widening of the sacral iliac joint here. If we do an x ray of the spine, we can see what we call squaring of edges, or the shiny corner sign. So if you look here, these corners or these edges of the vertebrae are somewhat shiny. So you can see here where there’s inflammation involved.
And as this condition progresses, the bones can fuse and the spine can become something we know as bamboo spine. So here’s an x ray image of a typical bamboo spine. So when you look here, there’s no separation of the vertebrae. They’re all fused. When we see bamboo spine, this is a very key finding with ankylosing spondylitis. So if you ever hear bamboo spine, it is ankylosing spondylitis.
How do we diagnose it? So diagnosis of ankylosing spondylitis is generally through clinical special tests to check for sacro iliitis. One of the tests is the Faber test or Patrick’s test, and that test is positive. So what an examiner does is that they flex the hip and the knee, they abduct the leg, and then they externally rotate, as you can see in this image here. If we get pain in the area of the sacro iliac joint, that is a positive test.
There’s also something we call the modified Chauber’s test, which is also positive in anklosyn spondylitis. This indicates decreased spinal range of motion. So generally what we do is that we make a mark at the dimples of venous and we make a mark about 10 dimples, and then we get the patient to flex, so we get them to bend over to try to touch their toes, and then we measure out again. And that new measurement should be greater than 15.
When we line up from the dimples to that ten centimeter mark, it should actually be greater than 15, least 15 cm. If it’s not, that is a positive test indicating a possible ankle spondylitis. So I know that’s difficult to understand by just hearing it, so please look it up on other videos to see what it looks like. So those are two clinical tests indicating sacro iliitis with fabers test, and decreased spinal range of motion with the showbirds test, indicating or increasing our suspicion of anklosing spondylitis.
So those can help with the diagnosis of ankylosing spondylitis. But another way to make the diagnosis is by looking at how long they’ve had the back pain and when it started. So if they had lower inflammatory back pain that’s been going on for greater than three months and that back pain started when they were less than 45 years of age, that is more likely to be ankylosing spondylitis. Again, lower inflammatory back pain.
So inflammatory back pain, so pain with prolonged morning stiffness, worse at night, and gets better with activity, that doesn’t completely give us the diagnosis. However, we still need to do some other testing. We can look at their HLA B 27 status. If they’re positive, that is also another point toward making the diagnosis, and we have to look at x ray findings. So if they have radiological findings that we talked about in the last slide, they do have classic ankylosing spondylitis.
And without radiological findings, that is non radiographic, axial spondyloarthritis. So with radiological findings, that’s a classic ankylosing spondylitis. Without radiological findings, that’s non radiographic, axial spondylo arthritis. So two different things. But if they have no radiological findings, but they have at least four of the symptoms or clinical findings we talked about in the last couple of slides, then not the radiological findings, but the other findings, like the inflammatory back pain, the enthusitis, acute anterior uvitis or the scleritis or the psoriasis, those types of symptoms or clinical findings.
If they have at least four of those, then that is ankylosing spondylitis as well. So again, we want to look at how long they’ve had inflammatory back pain. Has to be at least three months with an onset less than 45 years of age. HLA B 27 positive. If they have radiological findings, that’s classic ankylosing spondylitis. Without radiological findings, we have to do a bit more work. It’s non radiographic axial spinal arthritis.
If we have at least four symptoms or four clinical findings we talked about before, that’s an anklosing spondylitis. Again, again, it’s not clear cut because some individuals with ankylosing spondylitis don’t have HLA B 27 positive. So it’s a mix of all of these things that help us make the diagnosis, how do we treat it? So treatment of ankylosing spinylitis is started off with conservative measures, so the goal is to prevent or slow the progression of the spinal fusion.
So one of those ways is through physiotherapy. So physiotherapy can help reduce some of that mechanical stress. It sounds counterintuitive, but physiotherapy can help build some of those paraspinal muscles and other muscles to help support the spine. Exercise, particularly swimming, can also help with this as well. Breathing exercises can also help, and quitting smoking can also help reduce some of the inflammatory process of this condition as well.
With regards to pharmacological treatments, nonsteroidal antiinflammatory drugs or nsaids are the first line therapy. So you can think of things like naproxen or celicoxib. And for a lot of patients, all they need is a high dose of nsaids to help them with their enclosing spondylitis symptoms. But with prolonged high dose nsaids, we want to make sure that they’re protected in other ways due to the side effects of nsaids.
So we want to make sure they’re on a proton pump inhibitor for gastrointestinal issues due to the nsaids, we also want to keep an eye on their blood pressure and their kidney function. For other patients that have other issues like peripheral arthritis, we can use disease modifying agents so demards like methotrexate. And for patients that don’t respond to nsaids and don’t really respond to other treatments, we can use biologics. These are very expensive.
Some of these include tnf alpha inhibitors like golimumab, and then another class of biologics that can be used are the jack one inhibitors like upadocidinib. So if you want to learn more about other rheumatological conditions, please check out my rheumatology playlist. And if you haven’t already, please consider liking subscribing and clicking the notification bell to help support the channel and stay up to date on future lessons. And as always, continue to live, laugh and learn. And I hope to see you next time.
If you’re unsure of what ankylosing spondylitis, commonly known as as is, it’s an autoimmune rheumatic condition that primarily affects the spine as well as other joints throughout the body. To help explain it a bit better, I’m going to break it down into three parts, causes, symptoms, and how it’s commonly diagnosed. So to begin with, let’s talk more about the cause of ankylosing spondylitis.
Going back to as being a rheumatic condition, that means that there’s a condition in which your immune system has developed a fault, goes awry and begins to attack your own tissues. This is also referred to as an autoimmune disease. Many of these conditions are considered idiopathic or of unknown cause. Sometimes it’s the genes you’re born with. Other times it’s the result of something that affects you directly, like something that causes an infection.
As of today, doctors and researchers are stumped on what exactly causes as, which also means there is no known cure. However, it is known that genetics play a very important role, especially with a gene called HLA B 27. This is important to note most people who have as also have a gene that produces a protein called HLA B 27. I want to note though, being a HLA B 27 gene carrier does not mean a person will develop ankylosing spondylitis.
Less than one in 20 people with HlaB 27 gets as. It’s just an important link to the development of the condition. Also, HlAB 27 isn’t the only genetic marker linked with as, since researchers suspect more than 60 different genes have been associated with as. Particular environmental factors like a viral or bacterial infection may also be needed to activate as. There’s also research that may link intestinal bacteria as the trigger of the disease.
Additionally, the majority of those diagnosed with ankylosing spondylitis are caucasian males under the age of 45. Women can also have the disease, but men are twice as likely to get it. Again, there is no known cause or cure to as, but research is making headway on possible triggers and early detection signs that may help treat it with greater success. So next, let’s go over the common symptoms of as in better detail.
Just like any condition or disease, the development of ankylosing spondylitis, including the onset of symptoms can vary significantly from one person to the next. However, most symptoms will start to develop in late adolescence or early adulthood. In more rare cases, it’s possible to see symptoms start early in childhood. The most common early symptoms include frequent dull pain and stiffness around the lower back or buttocks.
The pain will gradually become more severe and frequent over the course of weeks to months. Initially, the discomfort is felt on one side, then may suddenly alternate sides. The pain is usually spread out or diffuse instead of pinpoint or localized. Pain and stiffness is usually worse in the mornings and during the night or after any long periods of inactivity. It’s usually relieved by heat, such as a warm shower, or with light stretches and exercises.
Other early stages of as include mild fever, loss of appetite and an overall general discomfort. This is because back pain and other symptoms from ankylosing spondylitis are caused by increased inflammation in the body that is being produced due to the autoimmune disease. As as progresses, the pain usually becomes more frequent and chronic and at this point is usually felt on both sides. Random flare ups of discomfort and significant pain can last for several weeks.
Over the course of months or years, the stiffness and pain may slowly work its way up into the spine and into the neck. It’s possible the pain and tenderness may spread to the ribs, shoulder blades, hips and ankles. The major hallmark sign of ankylosing spondylitis is pain and stiffness in the sacral, iliac or SI joints that progressively gets worse. The SI joints are located at the base of the spine where the spine joins the pelvis.
A classic symptom is when the SI joints start to hurt more at night and get better when you wake up and start to move around. Fatigue is another common symptom again from the inflammation being caused by as the body must spend energy to fight inflammation, which leads to fatigue. Also, it may cause mild to moderate anemia due to the inflammation, which can lead to the feeling of being tired and lethargic.
Other symptoms of ankylosing spondylitis may include bowel inflammation and eye or vision issues. As ankylosing spondylitis progresses into the later stages, the buildup of chronic inflammation can lead to a condition known as ankylosis, hence the name which bony formations start to appear in the spine and cause vertebra to fuse together in a locked, fixed position. Also, the ribcage can undergo calcification and fusion, which makes breathing difficult.
One of the most serious complications of ankylosian spondylitis in its later stages is the development of a hyperkyphotic hunchback posture. It’s commonly seen with individuals who poorly manage or completely leave the condition untreated. Why this happens is because as as progresses, the spine becomes stiff and rigid, slowly leading into a headforward position.
This position, not only being considered unsightly, may severely impact the range of motion of the neck and the back, leading to decreased quality of life. Postural exercises and maintaining good posture, without a doubt, is important at this point. So what diagnostic tests are available to detect and diagnose ankylosine spondylitis? The first steps are working with your doctor to have a comprehensive physical exam.
Blood work, including testing for HLAB 27 and imaging such as x rays being performed, also take into account individual medical history and any family history of as. These are important factors in making a diagnosis, here are some key factors in helping to diagnose it. First onset before 45 years of age chronic pain that persists for more than three months back pain and stiffness made worse within activity, especially at night and in the morning back pain and stiffness that gets better with light activity and exercise changes in normal back and neck range of motion, inflammation and tenderness around the spine and pelvis and any eye or bowel issues may help give clues too.
Going back to what I mentioned earlier, since it’s a big factor, the hallmark sign of as is the involvement of the sacral iliac or si joints. X rays can show sacro iliitis or erosion of the SI joints due to chronic inflammation. Sacral iliitis is extremely common with as, especially during its early stages. Sacral iliitis caused by this tends to be symmetrical, affecting both sides. Another important sign on an xray is the formation of syndesmophytes, which are thin bony projections that stick out from the corners of the vertebra.
As as progresses, it can start moving up the spine, leading to spinal joints becoming inflamed and syndesmophytes forming, eventually bridging, infusing two or more vertebra together. The end result of this process, as seen on an xray, is a radiographic feature called bamboo spine due to its similar appearance. A third radiographic sign is the squaring of lumbar vertebra. They may appear abnormally square from the erosion during the inflammatory phase.
With all this, you can see how x rays are extremely vital to doctors in helping to diagnose ankylosing spondylitis. So what’s the next step? If you’ve been diagnosed with as most people will end up working with a doctor that specializes in autoimmune disorders and arthritis called a rheumatologist. A rheumatologist will set up a treatment plan that may include medications such as nsaids or nonsteroidal antiinflammatory drugs, and prescribing physical and occupational therapy to help manage the symptoms.
Many patients also follow an antiinflammatory diet and find relief with chiropractic treatments, acupuncture, massage, and yoga at home exercises, especially those that focus on maintaining posture, are also beneficial. So if you have been diagnosed with as, make sure to consult with your doctor or your rheumatologist about treatment options and possible ways to help limit inflammation. Go to Home
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