Geeta Arora

ANKYLOSING SPONDYLITIS Ankylosing spondylitis is a progressive, chronic, seronegative inflammatory disease involving the spine & the sacroiliac & peripheral joints. Ankylosing spondylitis is characterized by inflammation of Sacro-iliac joints and spine, which can progress to bony fusion of the spine.

Epideomology
The peak age of onset is second & third decades, with a male: female ratio of about 3:1. More than 90% of those affected are HLA B27 positive. The overall prevalence is less than 0.5% in most communities. Over 75% of patients are able to live a good quality of life. Even if severe ankylosis develops, functional limitation may not be marked as long as spine is fused in an erect posture.

Clinical features/ Signs and Symptoms:

Anlylosing spondylitis is a form of arthritis which affects the spine. Patient presents in following ways:

• The onset is slow, with recurring episodes of low back pain and stiffness, usually patients start with lumbar symptoms.
• Symptoms are most marked in early morning and after rest or inactivity and are relieved by movement.
• Symptoms extend over many segments and axial and symmetrical.
• Some patients present with mainly thoracic or neck symptoms.
• The disease tends to ascend the spine slowly and after several years, whole spine may be affected.
• As the disease progresses, neck movements can also be restricted due to involvement of cervical spine interfering with forward vision.
• As the spine becomes progressively ankylosed, spinal rigidity and secondary osteoporosis predispose to spinal fracture. Spinal cord compression is rare.

Certain extra articular features are also seen in ankylosing spondylitis like Anterior uveitis & conjunctivitis, prostatitis, cardiac conduction defects, pulmonary fibrosis etc.

Signs:
Early signs:

• Failure to bend forward (forward flexion) and failure.
• Limitation of movement of spine in all directions, and possible pain on sacroiliac stressing.

Late stage signs:

• Spinal fusion
• Kyphosis
• Fixed flexion contractures of hips or knees.
• Costovertebral joint involvement in later stages can cause breathing difficulty as well as pleuritic chest pain.Plantar fasciitis, Achilles tendinitis and tenderness over bony prominences such as iliac crest and greater trochanter are common reflecting inflammation of sites of tendon insertion.

Extra articular features of AS

• Anterior Uveitis (25%) and conjunctivitis (20%)
• Prostatitis (80% men) usually asymptomatic
• Cardiovascular disease
• Aortic incompetence
• Mitral incompetence
• Pericarditis
• cardiac conduction defects
• amyloidosis
• atypical upper lobe pulmonary fibrosis

Cause

It’s thought to result from exposure to a common environmental pathogen in genetically susceptible individuals, although no specific trigger has been identified. Increased Klebsiella aerogens occus in patients with established AS and may related to exacerbation of both joint and eye disease.

Investigation Findings

• ESR & CRP : increased
• HLA B-27 positive
• RDW increased
• X-RAY
• MRI

X –Ray changes are characteristic but may take years to develop.
What do u see on X-ray:

• Sacroilitis is often the first abnormality beginning in the lower synovial part of the joints with irregularity and loss of cortical margins, widening of the joint space and then sclerosis, narrowing and fusion.
• Lateral thoracolumbar spine X-Ray : Squaring of vertebra due to erosion and sclerosis of anterior
  MRI – more sensitive – early detection of Sacroilitis
• Ossification of anterior longitudinal ligament and face joint fusion may be visible. Combination of these features may lead to Bamboo spine.
• Erosive changes may be seen in symphysis pubis, the ischial tuberosities and peripheral joints.
• Osteoporosis and atlanto-axial dislocation can occur as late features.

Management
The aim is to relieve pain, maintain mobility and prevent deformities & stiffness.

• Spinal extension exercises and breathing exercises can help.
• Swimming is a great exercise.
• Poor posture should be avoided.
• Avoidance of long hours of inactivity and taking breaks in between regularly.

Conventional treatment is with NSAIDs & analgesics. Also local corticosteroid injections are used. Surgery is done in cases of advanced deformity.

Homeopathy can be very helpful in case of Ankylosing Spondilitis as it can reduce inflammation of the joint as well as reduce to progression of disease to a great extent.

Auxially management of exercises is highly recommended along with homeopathic treatment. There is no specific medicine in homeopathy for A.S and treatment is based on totality presentation of case.

Few homeopathic remedies which can help in pain and inflammation are listed below but its strongly recommended to take medicine after seeing a Homeopathic practitioner in person.

OXALIC ACID: This remedy is suited when there is acute pain in the back & back is too weak to support the body. Pain worse from any kind of movement or exertion. Numbness is the characteristic.

CALCAREA FLUORICA: It has pain in the lower back, with fullness and burning pain. It is for backache simulating spinal irritation.

GNAPHALIUM: It is the remedy for chronic backache, with tired aching in the lumbar region.

RHUS TOXICODENDRON: Violent pain in the back, as if broken is the greatest characteristic. Suited for the chronic forms of backache where there is bruised & aching pains when attempting to rise or start any movement.

KALI CARBONICUM: Pains compel the patient to get up & move about mostly around 3 a.m. There are shooting pains down the buttocks. Pains in the back in the morning.

What are sinuses?
Sinuses are four pairs of air-filled cavities/spaces located in the skull in the region around the nose and the eyes.  Purpose of sinuses is to provide mucus to upper airways which provides lubrication to upper respiratory tract and also provides as a vehicle for  trapping viruses, bacteria, foreign material for removal, it give characteristics to  voice ,lessens the weight of the skull and is involved with smell recognition.

What is sinusitis?
Inflammation in the inner layer of these cavities in known as sinusitis.  When this happens, the sinuses get swollen and mucus secretion gets blocked inside the sinuses. The sinusitis can be infectious as well as non infectious. This can be nagging discomfort all the time or can have severe attacks which is varied for different patients.

What causes sinusitis can be?

• Obstruction of the various ostia
•  Allergic reaction to pollens, animal fur ,certain foods and beverages
• Deviated nasal septum ,nasal polyp
• Impairment in ciliary function( there are small hair like parts in our nose which prevent travelling of infectious agents or harmful substances to sinuses)
• Impaired immunity
• Bacterial infection or fungi (in rare cases like immunocomprised cases).

An interesting fact is that many people have sinusitis in spite of not having any of the above causes and even after removal of the cause, which shows that sinusitis is beyond these causes and is more likely like a tendency to sinusitis. Here homeopathy has a wonderful role can a correct homeopathic remedy given on basis of constitutional line of treatment can reduce and remove the tendency to sinusitis and you can live a life free from this nagging disease. Want to take the right remedy you can contact us.

Symptoms of sinusitis
Different people come down with different symptoms when it comes to sinusitis, you can have any of the following group of symptoms if you have sinusitis.

• Runny nose – the discharge being thick and yellowish or greenish
• Nasal obstruction, blocked nose, obstructed sensation in the nose
• Soreness in throat
• Sensation of pressure in the face and head/ Headache
• Passage of mucus from the back of the nose into the throat (called post nasal drip or discharge) which causes tendency to hawk or clear the throat often
• Bad breath and bad taste in the mouth
• Anosmia or reduced sense of smell
• Cough with mucus production (more at night when lying down)
• Blocked sensation in one or both ears

People with Chronic sinusitis will have following symptoms:

• Nasal discharge and irritation
• Hawking of mucous or clearing throat often.
• Dull Headache especially in frontal region.
• Facial pain or pressure
• Fever and halitosis
• Cough (worse when lying down)

Diagnosis : can be confirmed clinically as well as getting a paranasal sinuses x ray done. CT might be needed in certain cases.

Complications:
The blocked secretions can become infected due to growth of bacteria, fungi, etc. Infection of surrounding structures are uncommon complications of sinusitis. These structures include eye, the brain, the bone , overlying skin and nearby blood vessels.

Treatment
General management: Sinusitis can be well managed by medical treatment and self care. The conventional line of medicines offers decongestants, anti allergics and sometimes antibiotics as line of treatment.

Home treatment and self management include:

• Flush your nasal passages, clear your nose in morning
• Steam – you can add few drops of eucalyptus oil which can be beneficial
• Take a hot shower
• Take increased quantity of liquids which should be more of water and fresh juices ,avoid tea and caffeine
• Remove material from your house which can have allergy triggers , this sometimes helps as there might be triggring factors, like carpets, mould on walls, some plants
• Avoid humid areas
• Try jal neti- a yoga activity but should be learnt and done under supervision only (not during acute sinusitis )

Homeopathic treatment for permanent cure

Homeopathy has answer to this problem for it can resolve the acute sinusitis as well as drastically reduce the tendency to get sinusitis. For acute attacks are various remedies which can be prescribed based on symptoms of the case. Some examples are given below, but we recommend to consult a registered homeopathic practitioner. Also, for complete treatment of chronic or recurrent sinusitis one must see a homeopathic practitioner. A homeopath in such a case will prescribe a holistic remedy covering the physical symptoms and emotional attributes of patient so as find the remedy based on totality which will boost immunity and reduce or annihilate the tendency to sinusitis. At Dr Geeta’s clinic we have many cases of sinusitis treated successfully.

Few homeopathic remedies for acute sinusitis are:

Bryonia alba:  Nose catarrh extends to frontal sinuses .Frontal headache, frontal sinuses involved.

Kali bichromicum : Pressing in frontal sinuses ,catarrh in frontal sinuses. Pain at the root of nose,as if in the bones. Chronic inflammation of frontal sinuses with stopped up sensation.

Hepar sulph: ailments after exposure to cold air,, sinusitis. Post nasal discharge with much hawking of mucous. A noisy cough aggravated by cold draft of air and better by warm drinks.

Sticta :  headache will dull pressure in forehead, at root of nose. Catarrhal headache before discharge appears.

Pulsatilla pratensis – Congestion of blood to head and engorgement of the sinuses. Coryza with loss of smell and taste; dry and fluent alternately, or stopped up in evening, with loss of smell and taste and appetite; obstruction of nose in evening; yellow or yellow-green in morning; nostrils sore; frontal headache.

References :

• Davidson’s Principles and Practice of Medicine, 21st  Edition
• Boericke W, Boericke O. E. New Manual of Homoeopathic MateriaMedica& Repertory [with relationship of remedies]. B. Jain Publishers (P) Ltd, New Delhi –110055.
• Hering, C., The Guiding Symptoms of our MateriaMedica Vol. 1 to 10, Reprint Edition 1993, B. Jain Publishers (P) Ltd, New Delhi –110055.
• Gupta ,R. Directory of disease and cure in homeopathy , B. Jain Publishers (P) Ltd, New Delhi –110055.
• Satya, P. Analogy of Pain
•  http://www.webmd.com/allergies/sinusitis