'Spondy' what.....

Ankylosing Spondylitis - when your spine decides to get all bent out of shape about things....

Spondylitis and spondylosis are two different conditions which often get confused – because they both start with the word “spondy”, which just means the vertebral or spinal column.

The differentiation comes after that – “itis” means inflammation and “osis” just means “refers to” or “a condition”.

Spondylosis is from bodily wear and tear and can cause arthritis-related pain and stiffness: the disks and joints degenerate, and cause reduced spinal movement. Although it’s a type of arthritis, it’s not an inflammatory condition. Spondylosis mostly affects older adults.

Spondylitis on the other hand affects younger people and is a group of inflammatory conditions that affect the joints in the spine Spondylo” means spine, and “arthro” means joints. Ankylosing spondylitis (AS) is the most common of the conditions. Although anyone can develop spondylitis, it usually develops in younger adults: symptoms of AS typically start between the ages of 20 and 40 years old.

It’s unclear what causes AS, though it may be interactions between genetic factors, gut microbiota, mechanical effects on the spine and peripheral joints, innate immunity, oxidative stress, lifestyle and environmental issues.

Scientists have linked 113 different gene locations to the development of AS and some genes increase risk (though not all people with the genes develop AS).

Some conditions may increase your risk of specific types of spondylitis. For example:

• About 1 in 5 people with psoriatic arthritis develop psoriatic spondylitis.

• Inflammatory bowel disease may contribute to the development of enteropathic arthritis.

• Reactive arthritis typically develops after a gastrointestinal infection.

Treatment of AS is usually with biological therapy, (biologics) and complementary lifestyle and dietary therapy. There is overwhelming evidence of the importance of diet in the etiology of a wide range of diseases, including spondylitis.

Diet mediation is essential for people taking biologics, as these therapies suppress the immune system and increase the risk of infections. People who take biologics are more likely to get infections such as upper respiratory infections, pneumonia, urinary tract infections, and skin infections. Diet (and lifestyle) play a critical role in maintaining a high functioning immune system.

There is a strong association between high fibre consumption and reduced disease activity in patients with AS. In a recent study there was a “persistent negative correlation between high fibre intake and both ASDAS-CRP and BASDAI scores”. These findings reinforce and add to the existing body of literature that suggests the positive impact of fibre intake on AS.*

An examination of dietary patterns in a large cohort of nurses in the United States found that dietary patterns typical of industrialised countries (high intake of red meats, processed meats, refined grains, French fries, desserts and sweets, and high-fat dairy products) were associated with an increased risk.

Additionally, there is evidence that a low starch diet (processed flours, white rice and white sugar) leads to lower AS disease activity and that Klebsiella pneumoniae, which can be influenced by starch consumption, is a triggering factor involved in the initiation and development of AS.

Nutritional therapy

For spondyloarthritis in general, following anti-inflammatory diet is crucial to controlling pain and future bone growth.

• Avoid highly processed foods, particularly those high in saturated fats, sugar or salt.

• Given the potential role of bacteria in the gut influencing these conditions, ensuring optimal gut health is also required. Including foods which promote growth of healthy bacteria, known as probiotic foods: including sauerkraut, kimchi, yoghurt, onion, garlic, asparagus and watermelon.

• Eat a plant-predominant diet featuring fruit, whole grains and healthy fats from nuts, seeds and avocado. Eat a variety of healthy foods rich in antioxidants, such as colourful vegetables and fruits.

• Eat foods rich in omega 3 fatty acids, such as hemp seed, chia, walnuts and flax seeds

• No or very little added fats (especially saturated fat found in animal products), cholesterol, sugar, and salt in moderation.

• Eliminate hyper-processed foods, fried foods, and other products high in artificial ingredients and preservatives.

• Drink 8 to 10 glasses of water a day.

• Take a vitamin B12 supplement

It is important to find out from your doctor whether any medications you take affect how your body uses what you eat. For instance, some medications cause a person to retain sodium, while others cause potassium loss. Methotrexate can lower folic acid levels, causing a variety of adverse symptoms that can be offset by taking additional supplements. Talk with your doctor and/or pharmacist about potential interactions.

Calcium is found in all green leafy vegetables and many other plant sources – but to make sure that you’re getting the calcium make sure you eat the green vegetables with some sort of citrus – lemon juice or grapefruit slices, or orange.

Avoid alcohol or foods that can interact with your medication.

Both calcium and alcohol affect the strength of the bones; people with spondylitis are already at higher risk for osteoporosis, a dangerous thinning of the bones that can lead to fractures. A diet with adequate amounts of calcium and vitamin D will help reduce the risk of osteoporosis.

Consuming more than two alcoholic drinks per day increases a person's chances of developing weakened bones. In addition, alcohol mixed with certain medications can cause serious side effects to the gastrointestinal tract and major organs such as the liver and the kidneys.

*(Citation: Song C, Wang L, Ji X, Wang Y, Hu L, Liu X, Zhang J, Liao S, Yan Y, Zhu J, et al. Dietary Fiber Intake Influences Changes in Ankylosing Spondylitis Disease Status. Journal of Clinical Medicine. 2023; 12(4):1621. https://doi.org/10.3390/jcm12041621)