Doctors have long recommended doing some form of daily physical activity for patients with ankylosing spondylitis (AS) to reduce stiff muscles and limited mobility, and research has shown that home-based exercise programs can be beneficial. “Joints are made to move, and they are happiest when they are moving,” noted Dr. Smith. 

“With AS, the biggest progressive issue is a loss of mobility in the spine, and all the things attached to the spine,” explained Dr. Smith. Regular physical activity—including strengthening and stretching exercises that focus on good posture and a strong core—can help prevent some of the stiffness and loss of flexibility that comes with AS. “A weak core and poor posture can put added stress on the spine, which can exacerbate symptoms of AS,” she added.

In addition, exercises that strengthen the posterior chain, or back of the body, are also important, noted Sachdeva . “AS often pulls you into a forward flexed position and can make it difficult to extend your spine,” she explained. Strengthening the back of the body (including the back and glutes) can help counter this forward bend.

You don’t have to join a gym or seek out special workouts to get the benefits. A variety of exercises can easily be done at home with some basic workout tools that may help with managing AS, Sachdeva said.  

Read the full article at HealthCentral.com. 

“If you stay in any one position for too long, like being seated for several hours straight, it will cause stiffness and pain as inflammatory cells and proteins settle in the joints,” noted Dr. Smith. “This is most pronounced first thing in the morning as certain immune cells are more active at night, creating an accumulation of inflammatory cells and proteins by morning.”

Dr. Smith advised taking a two-minute movement break every 30 minutes or so when you’re seated at work or elsewhere. “Get up and stand instead of sitting, or if you can, take a short walk,” she said. “Movement increases circulation both of blood and of synovial fluid, which lubricates the joints.”

Read the full article at healthcentral.com. 

If non-steroidal anti-inflammatory drugs (NSAIDs) are not enough to bring pain relief, your doctor may prescribe more advanced forms of treatment, such as biologic drugs, which can be highly effective, Dr. Ashany said. 

“For patients with pain at the tendon insertions, braces can also be effective in calming down the inflammation,” Dr. Ashany said. Again, physical therapy may also be helpful, she added.

To help ease these symptoms related to AS, so you can feel your best, it takes a multi-layered approach of medications and other strategies. “The condition progresses variably in patients, and the majority of patients do well with a combination of medication and exercise,” Dr. Ashany said. 

Read the full article at healthcentral.com. 

In fact, people with AS who don’t exercise may experience more fatigue and pain because a lack of movement leads to decreased range of motion, stiffness, and muscle weakness. Staying active will not only help you manage the symptoms of AS but also help strengthen your spine for years to come.

Meanwhile cardio, like walking and swimming, can be just as beneficial as resistance training to strengthen your stabilizing muscles, said Darren Lebl, M.D., spine surgeon at HSS. “Cardiovascular exercise increases blood flow and oxygenation to tissues, diffusion of nutrients to joints and discs, and tones and strengthens supporting muscles. All of this leads to better musculoskeletal health and performance,” he explained.

Rule of thumb? Avoid activities that may cause you to feel pain and discomfort, cautioned Dr. Lebl. “AS patients should avoid activities that force excess motion. If an activity causes pain or discomfort, it is important not to push it and to back off because due to the inherent loss of motion with AS, it is possible to cause an injury if motion is forced,” he said.

Read the full article at Healthcentral.com. 

HSS physical therapist Wai-Kwong Hui, PT, DPT, MS, noted “If you’re not challenging yourself, you get stagnant." 

Challenging yourself physically doesn’t mean taking on big athletic feats that could land you on the couch with really bad back pain. It can be as simple as mixing up the balance activities you do so that you’re not always moving in the same way. For example, if you always do one type of yoga pose to work on balance, switch it up by adding another option to your repertoire. “It changes the position of balance all of a sudden,” said Hui . The best way to train for life is to train your body in all the ways that you might move, so that nothing takes you by surprise. For example, twisting moves can prep you for the motions required for putting away groceries or pulling laundry out of the dryer. Working your squatting muscles can build your ability to get up and down from seated or lying-down positions. 

Read full article at healthcentral.com. 

Maintaining your balance and flexibility are important for a few reasons, said Hui. First, when you have inflammatory arthritis, your joints can get stiff. “Once you stop moving, you’re creating rust. That’s going to make it harder to move,” noted Hui. As the old saying goes, “motion is lotion,” he added. Second, the pain and stiffness caused by these conditions tends to lead people to alter their movement patterns and move in ways that limit balance and mobility. Improving these skills requires working on them often—every day if possible, even if it’s just for a few minutes at a time—by doing exercises that challenge your body.

Hui recommends stretching in small amounts throughout the day, which has the added benefit of building in movement breaks. “If you’re sitting at a desk a lot, getting up and moving and stretching what’s tight is a great thing to do to change your position,” Hui says. Sitting in one position all day long contributes to stiffness and reinforces bad posture, so the more you can stand up and reset, however briefly, the better.

Hui suggests stretching the body parts that feel particularly tight—likely, different areas of the spine, shoulders, and neck, though the lower body can also contribute to overall stiffness and discomfort—and holding each stretch for 30 to 60 seconds to really feel the stretch response of the muscles and tendons. “You can work your way up even longer to really feel that stretch over time,” he adds.

Read the full article at healthcentral.com/.

In some instances, strength work is critical for relieving muscle tightness. If your chest is tight, it could be that your back muscles are a little too weak to properly pull you into an upright posture, Hui explained. This results in hunching forward into a position that closes and tightens the muscles in the chest.

Read the full article at HealthCentral.com.  

Though there’s not much data on how patients with AS are treated in the U.S. healthcare system, considering how biases in healthcare impact Black people with other conditions, there are likely a few factors at play said Dr. Ghosh.  Lack of access to specialists and medications for geographic or socioeconomic reasons are large factors. The other is that physicians are often taught that AS is a “disease of white people,” noted Dr. Ghosh. “So, there may be an unconscious bias that this can’t happen in a nonwhite person, leading patients to be dismissed, even when they have classic symptoms.”

Dr. Ghosh added that not enough Black people with AS have been included in research to draw definitive conclusions on genetic risk, and factors like socioeconomic status have not been explored fully. In a letter to the editor responding to that study published in The Journal of Rheumatology, experts point out that findings on racial differences in AS are likely skewed by how the research was done. 

Read the full article: https://www.healthcentral.com/. 

“When you sit around too much or do not move around enough, the muscles in your legs, trunk, and even the arms will become weaker and lose some of their flexibility,” explained Hui. That atrophy can make daily activities like climbing stairs or putting groceries away feel like workouts, he added.

Hui continued, ”Plus, in people with inflammatory arthritis, such as ankylosing spondylitis (AS) and rheumatoid arthritis (RA), lack of movement can translate to increased stiffness and pain in whatever joints are affected, be it knees, ankles, hips, feet, shoulders, wrists, hands, or the spine. And when one area is always stiff, it can cause additional tightness and pain elsewhere. Over time, you can also lose mobility and function.

Hui provided the publication with suggested low-impact strength and mobility exercises to improve function that will be featured and released in an article series in the weeks to come. 

Read the full article at HealthCentral.com.

Hui explained, “As you spend time in this posture, the muscles in the front of the body shorten, and muscles on the back of the body lengthen.”

“People with AS really need to remind themselves about their posture,” he noted.

Hui recommended the posture-training activity called the Kitchen-Bathroom Workout. He noted, “First thing in the morning when you get to work, go to the little kitchenette. Walk around and drink a cup of water. Finish drinking and then come back to your desk and work for 30 minutes. Then, go use the bathroom. Then, back to your desk.” Thirty minutes later, do it all over again: kitchen for water, desk, bathroom.

According to Hui, “When we’re working at a desk, it’s easy to lose track of time and then two hours later you realize you haven't moved from your desk. So this is a great way to force people to get out of that position.”

He explained that good, seated posture looks like feet flat on the floor in front of the body, shoulder blades back and down and chest up (but not flared out), and core engaged.

Read the full article at Healthcentral.com.

According to Dr. Lieber, “Frailty is increasingly recognized as an important risk factor for adverse health outcomes in multiple rheumatic conditions, including RA. We were interested in evaluating the prevalence of frailty in adults with AS and PsA relative to adults with RA.”

She continued, “We also were interested in assessing whether other clinically relevant factors, such as anxiety, were more common among frail adults compared to non-frail adults with any of these forms of inflammatory arthritis.”

Dr. Lieber explained, “Mental health, including anxiety, is important to consider in adults with inflammatory arthritis. To our knowledge, the higher prevalence of anxiety among frail versus non-frail patients with inflammatory arthritis other than RA has not been previously observed. The prevalence of anxiety in frail enrollees in this study, particularly among those younger than age 65, exceeded the prevalence of anxiety previously reported among Medicare enrollees.”

She added, “The association between frailty and anxiety in patients with inflammatory arthritis needs to be explored further. Whether or not the presence of mental health comorbidity may accelerate the development of frailty is unknown.”

Read the full article at Medpagetoday.com.

Dr. Ghosh noted, “Myths about AS are harmful because it prevents patients who may have symptoms of the disease from seeking care because they don't fit the typical mold of what an ‘ankylosing spondylitis patient’ looks like.”

AS can affect people of any gender, race, or ethnicity.

“I would much rather a patient come and see me and be evaluated for AS and for me to tell them that they don't have it, rather than a patient who has it and is silently suffering but doesn't believe that they have it because they don't fit the mold of these myths,” Dr. Ghosh added.

Watch the full interview at Healthination.com.

Dr. Ashany dispelled the myth that there is one test for diagnosing axSpA. On average, it can take seven years for someone to be diagnosed with axSpA, given the symptoms such as lower back pain. “For physicians not familiar with [axial spondyloarthritis] or not actively thinking about it, they may not pursue the proper tests,” said Dr. Ashany.

Another myth is a specific diet must be followed. Dr. Ashany cited, “There are no well-done studies to show that any particular diet makes a difference in symptoms. However, if a patient tells me that if they eat a particular food they feel much worse, then I tell them to avoid that particular food.”

A common misconception is that non-radiographic axial spondyloarthritis (nr-axSpA) always develops into ankylosing spondylitis (AS). Dr. Ashany explained that certain characteristics may help predict worse outcomes, and risk factors for progression to AS include: the male sex, elevated inflammatory markers, presence of the HLA-B27 gene and degree of inflammation seen on MRI of the SI joints. Still, even with these risk factors, not all patients progress, she added.

Finally, even though axSpA can cause permanent damage and structural changes to the spine, this can be avoided. “Patients have variable courses,” noted Dr. Ashany. “Some are never destined to develop progression or significant symptoms, and have quite a mild disease.”

Read the full article at CreakyJoints.org.

One symptom is shortness of breath and dizziness. Dr. Goodman said, “Some people with AS develop heart problems due to high levels of inflammation throughout their body.” After years of disease, some people may develop a heart condition of chronic inflammation around the aortic valve, called aortitis.

According to Dr. Goodman, although AS symptoms most commonly affect the spine and surrounding area, any joint can be affected — including the hips, ankles, elbows, knees, shoulders, or even jaw. “The stiffness, inflammation, and pain can spread up the spine and into the neck and other places.” She added that these symptoms are treated in a similar fashion to AS-related back pain.

Another symptom is heel pain. Dr. Goodman explained, “With AS there can be pain and tenderness in areas of the body where joints meet bone. And treating the underlying AS can also benefit heel pain.”

Finally, fatigue is also a symptom that can be overwhelming for some people. Dr. Goodman noted, “It’s a very nonspecific symptom, but it can signal that something inflammatory is going on in the body.” Further she added, “Pain can make you tired, and people with AS may have trouble sleeping comfortably, which can add to fatigue.”

Read the full article at EverydayHealth.com.

McInerney explained since people with AS have an elevated risk of osteoporosis, it’s worth brushing up or learning about those risks and what you can do to minimize them. According to McInerney, it’s important to maintain a healthy weight. “Keep your weight in a healthy range because if you are super underweight or super overweight, you have an increased risk for a fracture.”

McInerney suggested keeping a food log for a week to see if you’re hitting all the food groups and to identify your gaps. ChooseMyPlate.gov will also allow you to visualize what your meals should ideally be comprised of — mostly fresh fruits and vegetables with whole grains and lean protein. “It’s reminding people of all the food groups,” said McInerney. “One of the things that is not listed on there is processed food.” She added, “If you’re getting food in its natural form, you’re getting more of the nutrients you need. With any of these conditions [such as AS], people may focus on certain foods or a group of nutrients in search of a quick solution.”

McInerney advised to focus on the positive and what you can do, instead of what you can’t eat or drink. “The idea is moderation and variety in diet,” she said. “We’re not perfect; we try to hit all the food groups as best as we can.”

Read the full article at Everydayhealth.com.

The experts explained how the disease might progress differently in women compared to men, how treatment may differ between the sexes and how the condition might affect pregnancy and childbirth.  In 2009, doctors began using the umbrella term axial spondyloarthritis (axSpA) to refer to inflammatory arthritis that causes pain and swelling primarily in the spine and sacroiliac (SI) joints. There are two subtypes of axSpA: Nonradiographic axSpA (nr-axSpA), which means joint damage is not visible in x-rays; and Ankylosing Spondylitis (or radiographic axSpA), which means joint damage can be seen in x-rays. This new way of defining axSpA made it possible for the disease to be more visible in women, who tend to have fewer radiographic changes — damage that can be seen in x-rays — said Dr. Goodman. “Women are less likely to have radiographic damage, so if your screening procedure is an x-ray, you’re less likely to be able to confirm a diagnosis in a woman. MRIs have really changed that, and now we’ve seen more of a gender parity,” she noted.

AS is also often wrongly diagnosed as chronic back pain caused by minor trauma, bad posture, or poor body mechanics, said Dr. Goodman. Most doctors don’t routinely screen for inflammatory arthritis since lower back pain is so common. “I think that combination — normal x-ray, no consistent screening for inflammatory back pain, and I personally think that there is a tendency to disregard women’s musculoskeletal complaints — has been a real problem over time,” she said. Additionally, the fact that many women have lower back pain during pregnancy can make it difficult to sort out who may be experiencing symptoms of AS, cited Dr. Goodman.

Women with axSpA are also more likely to have elective C-sections and give birth to babies who are small for their gestational age, according to the Spondylitis Association of America (SAA). “If the sacroiliac joints are fused, it can be very hard for labor and delivery,” mentioned Dr. Goodman. “But in most cases, this really isn’t a problem, because one of the things that happens around the time of delivery is you release a lot of hormones that relax the pelvic ligaments and structure.” Not only that, but young women of childbearing age are also unlikely to have had the disease for a long time or developed fusion of the SI joints, she added.

Read the full article at Everydayhealth.com.

According to Dr. Chan, lack of finances, health literacy and social support all make dealing with chronic illness much more difficult. However, she suggested, “In the era of electronic health records, the ability of patients to message their doctors in real time is a nice feature — it makes patients feel like we are available to them. Support staff helping patients navigate the health care system, particularly prior authorizations and insurance kinks and the dreaded specialty pharmacies, can be helpful. Providing resources such as patient information pages from the Arthritis Foundation or UpToDate are useful, but a lot of my patients also have really been helped a lot by support groups that the Hospital for Special Surgery [HSS] makes available to patients. This makes patients feel less alone."

Dr. Chan noted, “Investing in oneself is huge and not often talked about. Some important examples include physical health (e.g., time or money spent either in physical therapy or at the gym or other physical activities that patients enjoy) and mental health (a good therapist can make a big difference dealing with issues that come up when one is dealing with a chronic illness)." 

Read the full article at Healio.com/news/rheumatology.

Poses include diaphragmatic breathing, side breathing, reclining pectoral stretch, thoracic rotation, cat-cow pose, bird-dog pose, sphinx pose, half-kneeling thoracic twist and yoga flow.

Read the article at Everydayhealth.com.

CreakyJoints spoke to Susan M. Goodman, MD, rheumatologist at HSS, who explained there are two main factors that contribute to the difficulty of diagnosing AS. “The first is the prevalence of back pain. One estimate is that 90 percent of people see a doctor for low back pain some time during their life, so the index of suspicion when a young, active person complains of back pain is low,” said Dr. Goodman. The second, is a long lag between the time when symptoms appear and when tests would confirm a diagnosis or even suggest AS in X-rays, she added.

Dr. Goodman noted symptoms of AS such as inflammatory back pain, in which occurs when the immune system mistakenly attacks the joints in the spine, differs from mechanical back pain, or aches caused by lifting something heavy. Inflammatory back pain improves with exercise and is worse with rest. With mechanical back pain, it’s the opposite: Rest makes it feel better and activity makes it worse, said Dr. Goodman.

Imaging studies are also a key factor in the diagnosis of AS. “If plain radiographs are normal, your doctor may order an MRI to look for inflammatory changes of the sacroiliac joints,” cited Dr. Goodman.

Read the article at Creakyjoints.org.