Ankylosing spondylitis
Ankylosing spondylitis, also known as “Marie Strumpell disease,” is a chronic inflammatory autoimmune condition that primarily involves the sacroiliac joint and gradually affects the axial skeleton with various skeletal and extraskeletal manifestations. This disease shows a strong association with the genetic marker HLA-B27. Early stages of this condition present with symptoms like inflammatory back pain and stiffness, whereas chronic conditions may produce marked axial immobility and deformity.
The unavailability of satisfactory treatment in the conventional medical system leads to permanent deformity in individuals. The symptomatic treatment that involves NSAIDs, corticosteroids, and Disease Modifying Anti-Rheumatic Drugs (DMARDs) has limited benefits and various side effects when used for long periods. Through ayurvedic medicines and panchakarma, the condition can be managed, and further progression is prevented to a large extent without any side effects. Ayurvedic treatment for ankylosis spondylosis also emphasizes the holistic management of back pain in Ayurveda.
Signs and Symptoms
- Dull pain in the lower lumbar, sacral, and sacroiliac regions
- Low backache with morning stiffness that lasts for a few hours
- Pain becomes persistent with bilateral nocturnal exacerbation
- Bony tenderness may be present at areas like spinous processes, costosternal junction, greater trochanters, ischial tuberosities, and heels.
- Enthesitis
- Dactylitis
Extra skeletal manifestations like:
- Irritable bowel syndrome (50%)
- Acute anterior uveitis (25-30%)
- Psoriasis (10%)
- Crohn’s disease
In chronic untreated cases, the patient’s posture gets affected, leading to lumbar and thoracic lordosis, buttocks atrophy, and stooping of the neck.
Diagnosis (ASAS criteria for axial spondyloarthritis)
- Inflammatory low back pain > 3 months
- Pain worse in the morning, morning stiffness lasts for more than 30 minutes
- Age of onset <40 years
- Limited chest expansion
- Limited motion of the lumbar spine in sagittal and frontal planes
- Unilateral grade 3 or 4 Sacroiliitis on radiographs or MRI
- HLA-B27 plus two or more spondyloarthritis features
Ayurvedic Perspective on Ankylosing Spondylitis
In Ayurveda, there is no specific correlation of the disease. AS can be correlated with a condition known as “Ama Vata,” which arises from the accumulation of toxins (Ama) and an imbalance in the Vata dosha (one of the three fundamental bodily energies). It can also be correlated with conditions like Katishoola, Asthimajja gata vata, Katiprishtagata vata, etc., based on the patient’s condition.
Ayurvedic Treatment Approaches
Detoxification (Panchakarma):
Panchakarma is a cornerstone of Ayurvedic treatment, focusing on cleansing and rejuvenation. For AS, specific Panchakarma therapies are highly effective:
- Deepana pachana: Deepana pachana drugs can be given to the patient for the correction of impaired agni. Drugs with katu, tikta rasa can be given, which will reduce the formation of the ama.
- Snehapana: Prior to any shodana procedure, various poorvakarma are performed. Before virechana (therapeutic purgation), medicated ghee is administered to the patient based on their agnibala (digestive fire) and disease condition. This helps accumulate the doshas for the purificatory therapies.
- Virechana (Therapeutic Purgation): This procedure induces laxation and removes toxins from the body, helping to balance the doshas. It helps balance the Pitta dosha and remove Ama from the body.
- Basti (Medicated Enema): Basti is highly effective in managing Vata disorders. It involves administering medicated oils or decoctions through the rectum to alleviate pain and stiffness.
External Therapies:
- Alepa chikitsa
- Dashamoola kwatha parisheka
- Dhanyamla dhara: A fermented preparation that helps reduce stiffness due to its tiksha ushna guna
- Abhyanga (Oil Massage): Regular oil massages with warm medicated oils like Mahanarayan oil or Dhanvantaram oil.
- Swedana (Herbal Steam Therapy): Swedana helps relieve pain and stiffness by inducing sweat and promoting detoxification. Sweda procedures like choorna pind sweda, valuka sweda can be used.
- Kati Basti: A specialized therapy where warm medicated oil is retained on the lower back using a dough ring, providing deep tissue relief and reducing inflammation. This is particularly effective for back pain in Ayurveda and is a significant part of the ayurvedic treatment for back pain and backache.
Lifestyle Changes:
Incorporating specific lifestyle practices can significantly improve the management of AS:
- Regular Exercise: Gentle exercises like yoga and stretching are beneficial for maintaining flexibility, strengthening the spine, and reducing stiffness.
- Stress Management: Practices like meditation, pranayama (breathing exercises), and mindfulness can help manage stress, which can exacerbate inflammation and pain.
- Adequate Rest: Ensuring sufficient rest and sleep is crucial for overall health and the management of chronic conditions.
Conclusion
Ankylosing spondylitis is a challenging condition that requires a multifaceted treatment approach. Ayurveda offers a holistic solution that addresses not just the symptoms but the root causes of the disease through detoxification, herbal remedies, dietary adjustments, lifestyle changes, and external therapies. By focusing on balancing the body’s energies and eliminating toxins, Ayurvedic treatments can significantly alleviate pain, reduce inflammation, and improve flexibility. Ayurvedic approaches for ankylosing spondylosis treatment also incorporate strategies for managing back pain in Ayurveda, making it a comprehensive plan for those suffering from such conditions. While Ayurveda provides a natural and comprehensive approach to managing AS, it is essential to work in conjunction with modern medical treatments and consult with qualified healthcare providers to create a personalized and effective treatment plan.