Ankylosing spondylitis and its homoeopathic management

Dr Priyanka Debnath

Abstract
Ankylosing spondylitis (AS) is a potentially disabling form of seronegative spondyloarthritis. The main symptom of AS is inflammatory spinal pain; with time, some patients develop ankylosis and spinal immobility. The pathology mainly affects the entheses, where ligaments, tendons and capsules are attached to the bone. Three processes are observed at the entheses: inflammation, bone erosion and syndesmophyte (spur) formation. The major causative factors of AS are genetic, with the gene encoding HLA-B27 being the most important genetic factor.

Key Words: Ankylosing spondylitis, Homoeopathy

Introduction:
Ankylosing Spondylitis is a chronic progressive immuno mediated inflammatory disoder of unknwon cause that primarily affects the spine. The name is derived from Greek words ‘Ankylos’ means fusion and ‘Spondylos’ means vertebra; ‘itis’ denotes inflammation. Hence the name described as Inflammation of vertebral column. 

Etiology: Etiology is unknown but probable etiological factors are- 

  • Genetic predispotion- large percentage of patient with AS share genetic marker  HLA B-27
  • Bacterias- Klebsiella pneumae and some other enterobacterias

Pathogenesis:
The pathogenesis of AS is poorly understood. Immune mediated mechanisms are suggested by inflammatory histology, raised serum levels of IgA and acute phase reactants, and the close relationship between HLA-B27 and AS. No single agent or event has been identified as the cause of the disease, but the interrelationship between AS, Rheumatoid arthritis, and IBD suggests that enteric bacteria may play a part. The disease is essentially a procress of calcification and then ossification of the ligaments and capsules of joints, which results in complete bony ankylosis of the central artifications of the body.

Clinical Features:
The first symptoms of AS usually appear in late adolescence or early adulthood and men are affected two to three times more frequently than women. The initial symptom is typically a dull pain that is insidious in onset. The pain is generally felt deep in the buttock and/or in the lower lumbar regions and is accompanied by morning stiffness in the same area that lasts for a few hours, improves with activity, and returns with inactivity. The pain becomes persistent and bilateral within a few months and is usually worse at night. In advance cases there is loss of spinal mobility, with restrictions of flexion, extension of the lumbar spine, and expansion of the chest. Most striking feature of AS is new bone formation in the spine that is Bamboo Spine which is repeated process of healing and bone formation leading to spinal syndesmophytes that is ‘Bone Bridges’. There are several extra-articular manifestations are acute anterior uveitis, IBD, Aortic insufficiency etc. 

Investigation:

The diagnosis of AS before the occurrence of irreversible damage is difficult. Several years may pass between onset of symptoms and definite diagnosis. This is unfortunate, as earlier diagnosis might potentially reduce the crippling effects that can occur.

  • Lab test: No laboratory test is diagnostic, although HLA-B27 gene present more than 90% of patients with AS. ESR, CPR and serum IgA often elevated in AS patients.
  • Imagine test: X-ray- Sacroiliitis is the hallmark of disease. CT, MRI may also be useful tools for monitoring of progression of disease.

Miasmatic Background:Dr. Hanemann mentioned in ‘The Chronic diseases’ that……From the malformations of the finger-nails up to the swellings of the bones and the curvature of the spine, and many other softenings and deformities of the bones, both at an early and at a more advanced age, are caused by the Psora. Thickening of the joints; they remain hard swollen, and there is pain on bending them. The joints, as it were, stiff, with painful, difficult motion, the ligaments seem too short. Joints painful on motion. Joints crack on moving, or they make a snapping noise. The joints are easily sprained at any movement. Softening of the bones, curvature of the spine (deformity, hunch-back)

Therapeutics:
It is desirable that while treating patient we strictly follow Homoeopathic law and methodology but here I have mentioned some medicines which may come frequently as a constitutional treatment and also mentioned some medicines which may come as pathological or specific medicine for ankylosing spondylitis.

Common Constitutional medicine:-
Aurum metallicum- 

  • Imagines he cannot succeed in anything, and he does everything wrong; he is in disunion with himself.
  • He is all the time imagining that he has neglected something, that he has neglected his friends.
  • Melancholy, feels hateful and quarrelsome. Terrible melancholy after abuse of Mercury.
  • Ailments from grief, disappointed love, fright, anger, contradiction, mortification.
  • Pain makes her desperate so that she would like to jump out of the window.
  • Like syphilis and mercury, the complaints are aggravated at night, coming on in the evening and keep up all night. The pains are violent, they tear, the bones ache as if they would break, not in acute fevers but in old syphilitic bone troubles.

    Calcarea phosphorica- 
  • Numbness and crawling are characteristic sensations, and tendency to perspiration and glandular enlargement are symptoms it shares with the carbonate.
  • Craving for bacon, ham, salted or smoked meats. Much flatulence.
  • At every attempt to eat, colicky pain in abdomen. Sunken and flabby.
  • Fistula in ano, alternating with chest symptoms.
  • Soreness in sacro-iliac symphysis, as if broken. Stiffness and pain, with cold, numb feeling, worse any change of weather.  

    Phosphorus-
  • Tall, slender persons, narrow chested, with thin, transparent skin, weakened by loss of animal fluids, with great nervous debility, emaciation, amative tendencies, seem to be under the special influence of Phosphorus.
  • Great susceptibility to external impressions, to light, sound, odors, touch, electrical changes, thunder-storms.
  • Ill effects of iodine and excessive use of salt; worse, lying on left side.
  • Thirst for very cold water. Vomiting; water is thrown up as soon as it gets warm in the stomach.
  • Burning in back; pain as if broken. Heat between the shoulder-blades. Weak spine.

    Silicea-
  • Imperfect assimilation and consequent defective nutrition.
  • Silica patient is cold, chilly, hugs the fire, wants plenty warm clothing, hates drafts, hands and feet cold, worse in winter.
  • Yielding, faint-hearted, anxious. Sensitive to all impressions.
  • Disgust for meat and warm food. Intolerance of alcoholic stimulants.
  • Fistula in ano. Fissures and haemorrhoids, painful, with spasm of sphincter. Stool comes down with difficulty; when partly expelled, recedes again.
  • Affections of finger nails, especially if white spots on nails. Soreness in feet from instep through to the sole. Suppurates.

    Tuberculinum-
  • When with a family history of tubercular affections the best selected remedy fails to relieve or permanently improve, without reference to name of disease.
  • Symptoms ever changing; ailments affecting one organ, then another – the lungs, brain, kidneys, liver, stomach, nervous system – beginning suddenly, ceasing suddenly.
  • Takes cold easily without knowing how or where; seems to take cold “every time he takes a breath of fresh air”
  • Emaciation rapid and pronounced; losing flesh while eating well 
  • Fear of dogs. Animals especially.
  • Averse to meat. Desire for cold milk.
  • Early-morning, sudden diarrhea.

Some Specific medicine

  • Aesculus hippocastanum- Severe dull backache in lumbo-sacral articulation; more or less constant; affecting sacrum and hips. Back “gives out”: during pregnancy, prolapsus, leucorrhoea; when walking or stooping; must sit or lie down. Sensation of heaviness and lameness in back. Paralytic feeling in arms, legs and spine.
  • Butyricum acidum- Tired feeling and dull pain in small of back, worse walking. Pain in ankles and up back of leg. Pain low down in back and limbs. Ankylosing spondylitis. Morbus coxae senilis.
  • Cimicifuga recemosa- Spine very sensitive, especially upper part. Stiffness and contraction in neck and back. Intercostal rheumatism.  Rheumatic pains in muscles of back and neck. Pain in lumbar and sacral region, down thighs, and through hips. Crick in back.
  • Colchicum autumnale- Pain with ankylosis of the back and neck. Burning pain in the neck, ameliorated by movement. Pain in the left scapula, aggravated on waking, by movement, and by lying on the left side.
  • Diacapetalum- Pain between the shoulders. Pain in the right shoulder, spreading towards the neck. Dorsal pain and stiffness like ankylosis. Severe pain and stiffness in the lumbar region, when seated or when walking. Pain in the lumbar region with drawing pains around the thighs. Drawing pains in the sacrum, ameliorated by urinating or expelling wind, worse when standing. Cellulitis of the nape of the neck.
  • Ruta graveolens- Pain in nape, back and loins. Backache better pressure and lying on back. Lumbago worse morning before rising. Spine and limbs feel bruised. Small of back and loins pain. Great restlessness.
  • Viscum Album- Feeling of a burning coal under the right shoulder is a key symptom. Lumbago from a chill, wants someone to press against the back. Stiffness and muscular pains in the nape of the neck, thoracic cage and back. Torticollis.

Conclusion:
So, I think we need more awareness about the disease with improvement of life style, food habit, and addiction. Apart from that by homoeopathic medicine we can treat a patient safely, effectively and economically. Homoeopathic treatment not only gives curative effects also give preventive one.

References:

Kasper, D.L., Fauci, A. S., Hauser, S. L., Longo, D. L. 1., Jameson, J. L., & Loscalzo, J. (2005). Harrison’s principles of internal medicine (19th edition). New York: McGraw Hill Education.

French, Herbert. French’s index of Differential Diagnosis. 15th edition. 2010. London. UK

Hahnemann, Samuel. The Chronic Diseases Their Peculiar Nature And Their Homoeopathic Cure. Reprint Edition 1994. B. Jain Publishers Pvt. Ltd.

Allen. H.C.. Keynotes And Characteristics With Comparisons Of Some Of The Leading Remedies Of The Material Medica With Bowel Nosodes. Edition 8th. Reprint 2004. B. Jain Publishers Pvt. Ltd.

Boericke, William. Pocket Manual Of Homoeopathic Materia Medica.Reprint Edition 2008. Allied Medical Publishers, Kolkata700101

Murphy R, Homoeopathic remedy guide: 1,200 Homoeopathic and Herbal Remedies. Reprint edition. Indian books and Periodicals Publishers, 2001

Julian, O.A. Materia Medica Of New Homoeopathic Remedies. Revised Edition 2011. Beaconsfield Publishers, 1979

https://ard.bmj.com/Last seen on 20.03.2019

Dr. Priyanka Debnath MD (Hom.) NIH
EX-SRF (H) at Central Council for Research in Homoeopathy, CRU (T) Gangtok,Sikkim- 737101
MO (RBSK) AYUSH at West bengal
9433650999

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