Burning Mouth Syndrome : What is it and what can you do to treat it?

We all know the painful feeling of scalding our tongue on a hot drink or bowl of soup. But what if that feeling never goes?

Burning Mouth Syndrome (BMS) is a quite common but little-known condition that is not life-threatening, but which sufferers say makes their ‘life a misery’.

Simply talking, eating hot or spicy food, like curry, and stress can all make it worse and there’s currently no known cure.

It can take years before the condition eases or disappears, so sufferers have to develop coping mechanisms to deal with the pain, which might include relaxation techniques such as yoga and meditation.

What is Burning Mouth Syndrome?

Sometimes also known as glossodynia, glossopyrosis, stomatodynia and oral dysaesthesia, BMS affects up to 15% of people and is more common in women than men – particularly women who are going through menopause.

While the burning pain or hot sensation can be felt just on the tongue or lips, it can also be more widespread throughout the mouth.

Other symptoms may include numbness, dryness and an unpleasant taste – and they can either be constant or come and go, according to the Department of Oral and Maxillofacial Surgery and Orthodontics at Oxford University Hospitals NHS Foundation Trust.

What causes Burning Mouth Syndrome?

The exact causes are unknown: some people have reported developing the condition after dentistry work, a throat infection or taking medication.

Studies suggest the pain is ‘neuropathic’, caused by nerves in the mouth malfunctioning – the way the tongue sends taste and sensations of warm and cold to the brain changes, resulting in pain.

What can be done about Burning Mouth Syndrome?

When you go to see your GP, they can refer you to the Oral and Maxillofacial Surgery and Orthodontics department of a nearby hospital.

Swabs will be done to rule out underlying conditions, such as a candidal (fungal) infection and your blood will be tested for levels of iron, vitamin B12, folic acid and glucose.

The Department of Oral and Maxillofacial Surgery and Orthodontics at Oxford University Hospitals NHS Foundation Trust advises:

“Living with ongoing physical symptoms is a challenge, but those people who do best, develop ways of making sure they continue to do things they enjoy as much as possible. This sometimes means actively challenging thoughts such as, ‘Having a meal is not the same as it used to be.’

“If the symptoms are causing you to stop doing things and you feel low, see your GP, who can refer you to a psychologist.”

What else will help ease the pain?

The burning sensation often feels worse when it’s accompanied by dryness, so it’s recommended that you drink plenty of plain water and chew gum to keep your mouth moist.

Avoid eating and drinking things that irritate your mouth, including fizzy drinks, alcohol, spicy and acidic foods, such as tomatoes and citrus fruit.

Finding a way to relax, such as doing yoga or meditation can also help you manage the pain.




Combination of NSAIDs and TNF-inhibitors shows benefit for ankylosing spondylitis

A combination of nonsteroidal anti-inflammatory drugs and TNF-inhibitors may help slow down spine damage in ankylosing spondylitis, according to new research findings presented this week at the 2016 ACR/ARHP Annual Meeting in Washington.

Ankylosing spondylitis (AS) is an inflammatory form of arthritis that frequently affects the joints of the spine. It’s more common in men. People with AS often are negative for rheumatoid factor, but positive for the, [gene or allele — depending on target audience] Human Leukocyte Antigen (HLA) B27.

Recent research on the effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor inhibitors (TNFi) on patients with inflammatory arthritis has been mixed, so researchers at the University of California, San Francisco in conjunction with several other investigators conducted a study to analyze the direct and interactive effects of a combination of the two therapies on radiographic (X-ray) progression of AS. The study was a multicenter cohort funded by the National Institutes of Health (NIH).

“Until 2003, the only drugs available to treat AS were NSAIDs. When the first TNFi was approved in 2003, the disease state changed. Suddenly, we could offer therapies to patients with incredible efficacy,” said Lianne S. Gensler, MD, Director of the Ankylosing Spondylitis Clinic at the University of California, San Francisco, and the lead author of the study. Despite the robust clinical response, TNFi could not show the disease progression (by X-ray) slowing down, she noted.

“Researchers posited that there was a different mechanism to explain the damage that occurred in AS, and that though we were treating the inflammation, we may not be addressing the ankylosis that appeared to continue. At the same time, several studies came out looking at NSAIDs to see if they could slow down progression, and these results were mixed,” she said. “Despite the controversy, as we saw patients on these drugs over the next decade, the clinical experience did not match the ‘evidence’ that suggested no effect. Patients were not developing the severe damage we had become accustomed to. Based on the controversial data, and having prospectively collected detailed medication data in a longitudinal cohort [PSOAS — Prospective Study of Outcomes in AS] over 10 years, we were able to ask the research question in a longitudinal manner, not only addressing the effects of TNFi, but also NSAIDs and the relationship between these two medications.”

The study included 527 AS patients who met the modified New York criteria in a prospective cohort with at least two years of clinical and radiological follow-up. The researchers defined radiographic progression longitudinally, with a ≥2 modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) unit increase in 24 months. Patients with high mSASSS scores were censored if they could not meet the progression definition over the next follow-up period. They used a longitudinal, mixed-effects, multivariate logistic regression model to find associations with NSAID and TNFi therapy and radiographic progression.

The patients in the study were 76 percent male, had a mean age of 42.7 and mean disease duration of 18.45 years. Their baseline median mSASSS score was 5.36, and they were followed for a median of 3.67 years. Seventy-eight percent of the patients used NSAIDs, and 58.4 percent used TNFi drugs. Multivariate results of the study showed that there was significant interaction between TNFi and NSAIDs. When TNFi were used with higher doses of NSAIDs (at least 50 percent of the maximum daily dose), patients had a 70 percent reduction in radiographic progression.

“This is the first study to show this relationship and potentially sheds light on why prior study results have been so controversial,” said Dr. Gensler. “I think it is important to remember that despite the results, not every patient will progress or warrant this kind of regimen. That said, for those with greater risk, this combination may be especially helpful.”

The researchers will next analyze another year’s worth of data to clarify their findings even more, Dr. Gensler said.

“It is also important to remember that this is a cohort of patients being studied, not a randomized controlled trial, so there may be unmeasured confounders and biases with regards to why various medications are used by different patients,” she said. “In the future, a randomized controlled trial with a radiographic outcome may allow us to answer the question in the purest way.”



8 Diet Do’s and Don’ts for Ankylosing Spondylitis

Eat your way to relieving arthritis of the spine.

Low-starch. Low-fat. Low-carb. When it comes to diets, the advice for staying healthy can make your head spin. If you have ankylosing spondylitis (AS), the fuel you choose can make a big difference in how you feel every day. Here are some rules for making the most of your meals.

1. Do: Eat a well-balanced diet.

Your body needs a wide variety of nutrients to cope with the challenges of daily life with AS. Eat plenty of fresh, healthy foods, including fruits, vegetables, and whole grains. Consume limited amounts of fats, especially saturated fats found in animal products. Steer clear of diets that eliminate entire food groups or allow you to eat only a few select meals.

2. Don’t: Fall for fad diets.

You’ll likely come across ads or articles about the latest nutritional cures for arthritis. But no diet has been shown to ease all symptoms or cure the disease. Some of these plans actually harm your health. Avoid diets with high-dose alfalfa, copper salts, or zinc, or that severely limit calories and fat. And always work with your health care provider or a nutritionist to ensure you’re getting the proper nutrients.

3. Do: Track your eating habits.

Foods that might work fine for one person with AS can aggravate symptoms in others. Keeping a food diary for a few weeks can make a big difference. Write down what you eat and when, and then note what happens to your symptoms. You may find some foods trigger flares, while others help you feel better.

4. Don’t: Drink too much alcohol.

People with AS have a higher risk for the bone-thinning disease osteoporosis. Beverages containing alcohol weaken your skeleton, especially if you sip more than two per day. Alcohol may also interfere with some medications. Check with your health care provider or pharmacist to see if drinking is safe for you.

5. Do: Get enough calcium and vitamin D.

These two nutrients strengthen bones, reducing your risk for osteoporosis. Most adults need 1,000 to 1,200 milligrams of calcium per day, but ask your health care provider how much you require. Calcium-rich foods include dairy products, kale, broccoli, and fortified cereals or juices. Vitamin D is found in some fish, and your body produces it when exposed to the sun. Your health care provider may recommend supplements.

6. Do: Ask how your medications interact with your diet.

Different medicines for AS will affect your body’s ability to absorb electrolytes and nutrients in different ways. For instance, some medicines may cause you to retain sodium, while others reduce your levels of potassium or folic acid. You may need to eat special foods or take supplements to offset these imbalances. In other cases, you’ll need to avoid certain foods that can interact with your medicines. Your health care provider or pharmacist can explain more.

7. Do: Maintain a healthy weight.

Balance the amount of calories you take in with those you burn to stay in a healthy range. Extra pounds stress your joints and bones, potentially worsening your disease. On the flip side, being underweight increases your risk for complications, from fatigue to anemia to osteoporosis. Your health care provider or nutritionist can help you find middle ground.

8. Do: Swap red meat for other options.

Most people with AS do best if they eat no more than two meals per week containing red meat. That’s because meat contains a compound called arachidonic acid. This can aggravate the inflammation that causes symptoms. Fish is a good alternative because it contains inflammation-fighting omega-3 fatty acids. Keep fish consumption to twice a week, too. Flaxseed and walnuts are other great sources of omega-3.



Ankylosing Spondylitis and fibromyalgia: Woman describes treatment ‘life-changing’

The conditions cause Lucy Gorton, 42, from Stroud, to suffer severe pain, with muscle spasms, trapped nerves and no energy.

But she has since tried out a vibration training platform which she said has improved her symptoms.

Ankylosing spondylitis (AS) is a chronic condition in which the spine and other areas of the body become inflamed.

Fibromyalgia causes pain, including aches, a burning sensation and sharp, stabbing pains all across the body. Her condition has even caused her to stop working.

Ankylosing spondylitus and fibromyalgia

Ankylosing spondylitus and fibromyalgia can cause extreme pain: Lucy at home

“I suffer from Ankylosing Spondylitis and Fibromyalgia, amongst other debilitating illnesses,” said Lucy.

“My various conditions cause severe joint pains and inflammation, muscle aches and fusing of the back, and I often feel drunk with fatigue and no energy.

“I frequently pull muscles and they spasm and spread. I get a burning sensation down my spine and frequently get trapped nerves in my lower back and down my legs.”

Both Ankylosing Spondylitis and Fibromyalgia leave individuals with extreme tiredness and all-over pain, meaning Lucy has been forced to drastically alter her formerly-energetic lifestyle.

Experts argue the onset of long-term debilitating illnesses can be difficult to contend with, but for previously fit and active individuals, they can change lives beyond recognition.

Routine exercises gradually become too painful to bear, meaning general fitness can often decline.

“I am unable to lead a normal life like that of someone my age. I have to plan my day around my energy levels and pains, whereas before I was an outdoor person who had horses and animals,” said Lucy.

“I have had to change my life.”

Desperate to find a solution to her daily problems and pain, Lucy bought a Vibrostation Home Studio – a piece of vibration training equipment which works by sending pulses around the body, causing rapid involuntary contractions.

Ankylosing spondylitus and fibromyalgia

Ankylosing spondylitus and fibromyalgia: Lucy said she was previously very active

The process exercises almost every muscle in the body and has been used by both Olympic athlete training programmes and space agencies, with the latter deploying it to help counteract the osteoporosis effects of weightlessness.

“I bought Vibrostation specifically to help manage my aches and pains and to keep as mobile as possible,” Lucy explained. “It is a great way to start the day.”

“It wakes up all the joints and muscles, increasing my energy levels to begin my day without wearing me out. It has made me feel more stable and less fragile, with my muscles toning up and feeling stronger.

“When you cannot face driving to the gym, or changing into gym kit it is so easy just to get on the Vibrostation.”

Lucy now uses the technology for 10 minutes every morning and has said it helps her to control her illnesses.

Ankylosing spondylitus and fibromyalgia can cause extreme pain

Ankylosing spondylitus and fibromyalgia: Lucy said the equipment has helped her manage the condition

“It isn’t a cure for the conditions but it helps to manage them.

Lucy said before she used the equipment she was pulling muscles continuously.

She added: “My flare-ups of the Ankylosing Spondylitis are extremely painful but thanks to the Vibrostation the motion eases and controls the spread of muscle and joint spasms.

“My recovery, therefore, is so much quicker. I rarely have muscle aches and joint pains throughout the day anymore.

“I suffer from a liver disease, primary biliary cholangitis, and I’m regularly scanned for osteoporosis.

“Weight bearing exercise is crucial and by using the Vibrostation I feel I am being proactive in delaying the onset of it.”

Lucy has been using the vibration training for six months, and described it as ‘life-changing’.




I have had the most overwhelming response to my post ‘My Journey to diagnosis – Ankylosing Spondylitis’; I have been amazed that most, have been on a long journey to diagnosis, just as I have, with most having an 8 and a half year delay in diagnosis.

The National Ankylosing Spondylitis (AS) Society, have just launched a new campaign, Back Pain Plus, to help reduce this delay. Back Pain Plus is an awareness campaign by NASS aimed at professionals seeking to reduce the current delay in diagnosis for people with Ankylosing Spondylitis (AS) in the UK.

I wish this campaign the very best of luck and hope professionals can start identifying symptoms earlier for those who are fighting for answers and for those, who like me, are still trying to get their heads around the condition.

As someone who is newly diagnosed, I am still very much learning about my condition and still find it near on impossible to explain to people what it is, as well as explaining what this means for me and my life. From the feedback I have received, I know that I am not alone in this, so I have decided to write down the 10 things that myself and other people with AS, this invisible illness, would like to explain to you about being diagnosed with Anklyosing Spondylitis (AS).


Don’t misunderstand any of what follows, just because I have this condition, it doesn’t make me miserable, feeble or someone who is defined by AS and sits around moping. I am an incredibly active, positive, upbeat person, but I am also someone who struggles to explain the symptoms I experience most days and what this diagnosis means to me, so, I thought I would write it down in layman’s terms to give those who don’t understand, a better insight into AS. Chronic pain and fatigue are invisible, so let me explain as best I can…


Just because I can’t make all the dates thrown at me and I’m not meeting up every week, it doesn’t mean that I don’t want to be friends. I am just in pain, exhausted or simply having such a good day that I am finally able to get on with things.

I may cancel plans, but please don’t exclude me, I am still here. I do care about you and I do want to hear from you.


My illness is invisible, I don’t have a cast, a sling or broken skin; on the outside I am smiling, I am active, I am positive, but turn me inside out and you would see it all.


I haven’t given up hope; I do believe there will be a time when I will have more answers or something that will help my symptoms, but this isn’t a bug, this is a lifelong illness.


If you want an idea of how it feels to wake up with this, I can only explain it as waking with that feeling you have when you have dreadful flu; there is simply no energy, your joints are sore and you just want to stay in bed.

Now imagine, that after days of fatigue and/or pain, just pushing through and doing the best you can, there is someone looking at you, expectantly, almost telling you rather than asking, “you’re feeling better, aren’t you?” or an irritated face, fed up of hearing how tired you are and that you’re still not feeling on top of my game…

So, when I am asked if I’m feeling “better”, I never know what to say; I worry that I am letting people down for being honest, or because I’m not miraculously any better, or because people will think less of me because I’m not feeling well. Chances are, most times that I am asked, I will tell you that I am absolutely fine and just press on… that’s just the sort of person I am.


A hug, an extra hour in bed, a text message, a card, a knowing look can make me feel so much better. It’s not giving me all the answers and trying to “fix” me, it’s just knowing that you realise that I am going through something and you are there for me.

I have the most fabulous friend who turned to me the other day, in a room full of people, gave me such a kind, thoughtful look and quietly said, “are you in pain today?”. She knew that I was and just knowing that she was there for me and had the ability to read me and how I was feeling, made me feel like I wasn’t alone in this. It really is the little things that really matter when you have a condition like this.


Just because you can’t see it, it doesn’t mean I am not in pain. If I look bored, chances are I’m not, I am either completely exhausted and trying my best to take things in, or I am in a huge amount of pain and trying my absolute best to appear happy and “normal”.

Pain and fatigue are incredibly distracting, they are both emotionally and mentally draining. I always try my very best to be ‘on the ball’ and alert when I’m out socially or just with my family, but if I seem to be a little absent, please don’t take it personally!


Some days seem absolutely fine, some are much worse, others are better than normal, and some, I can be feeling somewhere close to normal.

Catch me on a good day and there is no stopping me. Physically feeling good, is just about the best feeling in the World because it means I can actually get things done!! On a bad day, despite having no energy at all, I will most likely press on with my day, but I will be completely out of spoons (see below for ‘Spoon Theory‘) by late afternoon and have nothing left to give.


As a mother of a toddler, a dog owner and a wife to a man who works 6 day weeks, sleep and rest isn’t something that happens an awful lot in our house. If I am taking an extra five minutes to get out of bed in the morning, “being boring” having an early night, or I don’t fancy an all day/late night party, don’t judge me, I probably just need to rest.

Sometimes, I am just so tired from putting a lively, spritely face on things. Even if I am getting lots of sleep, I wake tired, so go easy on me, I’m trying my very best! I am absolutely not lazy, in fact, most people with AS, have to work twice as hard to simply accomplish most of the items on our ‘to do list’, the same things that most “healthy” people can complete in no time at all.


I really, really appreciate your thoughts and the time you have taken to read up on AS and the ‘wonder cures’. I realise that diet has a huge impact on this illness and general health, I know there are drugs out there that can help; all of these things I know and if they were relevant to me, I would have tried them out by now. Please don’t think that I am not grateful, I am, but I am also doing a lot of research myself and if there was a “quick fix”, I would be better by now.


Just because I have this condition, it doesn’t mean that I don’t have a life, interests, dreams or a lot of fun. I have all those things every day; I work incredibly hard to live, work and am always busy and planning lots of things. There is so much bubbling away for us as a family, and personally, there is so much I want to do on a daily basis and I actually think I’m doing a pretty good job of things!




Understanding the Progression of Ankylosing Spondylitis

Back pain is a common medical complaint today, but too many people are quick to dismiss it as a natural part of aging or just an annoying problem. Chronic back pain isn’t normal, and it isn’t a condition that should be left untreated. It may be a symptom of ankylosing spondylitis. As much as one percent of Americans, or about 2.7 million adults, may be affected by the disease. Click through this slideshow to learn about ankylosing spondylitis and what effects it might have on your body.

What Is Ankylosing Spondylitis?

Ankylosing spondylitis is a progressive inflammatory disease and form of arthritis. The disease causes swelling in the spine and nearby joints. Over time, the chronic inflammation can cause the vertebrae in the spine to fuse together. As a result, the spine becomes less flexible. Many people with the disease hunch forward to compensate for their rigid spine. In advanced cases of the disease, the inflammation may be so bad that a person cannot lift their head to see in front of them.

Who Is Affected By Ankylosing Spondylitis?

The most common risk factors include:

  • your gender: Men are more likely to develop the disease than women.
  • your genes: Researchers have identified a gene that is common in people with ankylosing spondylitis. The HLA-B27 gene is found in about eight percent of Americans. However, only about two percent of people born with the gene will actually develop the disease.
  • your age: Ankylosing spondylitis generally first shows signs and symptoms in young adulthood.

Beginning Stages

The earliest symptoms of ankylosing spondylitis are easy to ignore. That’s why most people don’t seek treatment until after the disease has progressed.

The first symptoms include:

  • back pain
  • stiffness
  • increased symptoms after sleeping or being inactive for a long period of time

Ankylosing spondylitis often affects these joints:

  • the joint between the spine and the pelvis, known as the sacroiliac joint
  • the vertebrae in the lower back
  • where tendons and ligaments attach to bones, known as the enthuses
  • hip joints
  • shoulder joints
  • the ribs and breastbone

When Ankylosing Spondylitis Is Left Untreated

If left untreated, chronic inflammation can ultimately cause the vertebrae in the spine to fuse together. You may have decreased range of motion when bending, twisting, or turning. You may also have greater, more frequent back pain.

Spine and vertebrae inflammation can spread to other joints, including the hips, shoulders, and ribs. The inflammation may affect the tendons and ligaments that connect to the bones. In some cases, the inflammation can spread to organs, such as the bowel or even the lungs.

The Dangers of Going Untreated

Leaving ankylosing spondylitis untreated may lead to one of these conditions:

  • uveitis: inflammation that spreads to the eyes may cause pain, sensitivity to light, and blurred vision
  • difficulty breathing: rigid joints in your ribs and breastbone may prevent you from breathing deeply or fully inflating your lungs
  • fractures: Damaged, weakened bones may break easily. Fractures in the spine can damage the spinal cord and the nerves around it.
  • heart damage: Inflammation that spreads to your heart can cause an inflamed aorta. A damaged aortic valve may impair the heart’s ability to function properly.

Other Common Conditions in Ankylosing Spondylitis Patients

There are a few conditions that are more likely to occur in people who have the disease. These disorders or diseases include:

  • psoriasis: Psoriasis is a common skin disorder that causes red, scaly patches of skin.
  • osteoporosis: Weakened bones are common in people with ankylosing spondylitis. These weak, fragile bones give way to osteoporosis. Up to half of all patients with ankylosing spondylitis also have osteoporosis.

Working with Your Doctor

Ankylosing spondylitis has no cure. The earlier you and your doctor detect and diagnose it, the better. Treatment can help prevent worsening symptoms and ease what you’re experiencing. It can also slow the progression of the disease and delay the onset of additional problems.

It’s important that you work closely with your doctor to find a treatment plan that best addresses the discomfort and problems you’re experiencing. Though you can’t cure it, you can find help. Treatment can help you lead a normal, productive life, despite your diagnosis.



Can Yoga Relieve Your Symptoms of Ankylosing Spondylitis?

How yoga helps ankylosing spondylitis


  1. Yoga uses gentle stretching exercises to help relieve pain and increase flexibility.
  2. Performing a single yoga pose now and then probably won’t do much to relieve back pain. Consistency is key.
  3. The cow pose warms the spine and releases spine tension.

Lower back pain can be debilitating. Pain caused by ankylosing spondylitis (AS) may be especially severe. Conventional pain relief medications may cause uncomfortable side effects. If you’re looking for an alternative treatment, yoga may help.

Yoga uses gentle stretching exercises to help relieve pain and increase flexibility. It helps stabilize your core to better support your spine.

A 2012 meta-analysis of 10 studies found yoga helps relieve chronic lower back pain. The study also concluded yoga can be recommended as a therapy to back pain patients who do not improve with other self-care treatments.

Yoga’s benefits for AS patients aren’t just physical. According to a 2012 study published in Indian Journal of Palliative Care, yoga promotes relaxation and helps reduce anxiety. It may also calm your nervous system, reduce pain and fatigue, and help you cope with the emotional issues of dealing with a chronic illness.

Part 2 of 7

Yoga poses for ankylosing spondylitis

Performing a single yoga pose now and then probably won’t do much to relieve back pain. Consistency is key. Doing a series of yoga poses daily may be more likely to bring you pain relief.

When you do yoga is important, too. You may be too stiff when you wake up to do a full routine. Choose a time of day when your muscles are more relaxed. You can also break up poses throughout the day. Try easier poses in the morning and more difficult ones later.

Here are nine yoga poses that may help relieve AS pain:

1. Child’s pose

The child’s pose stretches your lower back and hips. The Art of Living offers video instructions on how to do it properly.  

2. Bridge pose

The bridge pose stretches the spine, neck and chest. View step-by-step instructions from Yoga Journal.

3. Downward facing dog

Downward facing dog stretches your back and promotes flexibility. The Art of Living offers tips for getting this beginner pose right.

4. Cobra pose

The snake (cobra) pose stretches your back, lungs, and chest by lifting your chest off the floor while straightening your arms. Yoga Journal provides instructions on how to do it properly.

5. Locust pose

The locust pose strengthens lower back muscles. Yoga Basics provides directions and variations for beginners.

6. Mountain pose

The mountain pose is a simple stretch with a big impact. Gaia explains how to do this pose correctly to improve posture.

7. Cat pose

The cat pose strengthens and elongates your spine and neck. Yoga Learning Center shows you how.

8. Cow pose

The cow pose warms the spine and releases spine tension. Yoga Journaltells you how to do the pose and how to transition between cow and cat poses.

9. Staff pose

The staff pose strengthens your core, improves posture, and stretches your neck and shoulders. Yoga International offers instructions and breathing tips to help you get the most out of this stretch.

Part 3 of 7

Understanding ankylosing spondylitis

AS is an inflammatory condition. The inflammation may cause some of the vertebrae in your lower back to fuse together. It may also affect other areas, such as the:

  • areas where bones attach to tendons and ligaments
  • cartilage between your breastbone and ribs
  • hip and shoulder joints
  • joint between the base of your spine and your pelvis
  • eyes
  • heels

Part 4 of 7

What are the symptoms of ankylosing spondylitis?

AS symptoms may be sporadic. They may get worse or improve at times. Lower back pain is the hallmark symptom of AS. Other symptoms may include:

  • stiffness in your lower back and hips
  • worsening pain and stiffness in the morning or after periods of inactivity
  • buttock pain
  • difficulty breathing deeply
  • red eyes
  • blurred vision
  • light sensitivity
  • hunched posture

Advanced AS may involve the cardiovascular and pulmonary systems.

Learn more: Tips for beating ankylosing spondylitis fatigue »

Part 5 of 7

What causes ankylosing spondylitis?

It’s not clear what causes AS. It does have a strong genetic disposition, though. The condition is diagnosed through a physical exam, blood tests, and radiologic tests, such as X-rays.

Blood tests check for the human leukocyte antigen B27 (HLA-B27). If you’re positive for the antigen, you may be at risk of developing AS. Although many people with AS are positive for HLA-B27, not everyone with the antigen develops the disease.

You may also have a higher risk if:

  • you’re a man
  • you’re an adolescent or young adult
  • you have a family history of AS

Part 6 of 7

Treating ankylosing spondylitis

AS is a chronic condition, and there isn’t a cure. Treatments are aimed at managing the disease by relieving pain and preventing spinal defects. Treatment options include natural remedies and medication, such as:

  • over-the-counter NSAIDs to reduce inflammation
  • medications that block inflammation-causing TNF proteins
  • physical therapy and yoga to increase range-of-motion, flexibility, and posture
  • joint replacement surgery and spinal surgery

The National Ankylosing Spondylitis Society (NASS) of Britain recommends yoga to help relieve AS pain. Yoga may also improve your range-of-motion and flexibility. But its benefits don’t stop there. Yoga’s deep breathing promotes ribcage expansion to improve breathing. It also relieves stress and helps you relax.

Part 7 of 7

The Takeaway

Keep in mind that some yoga poses may be difficult or even painful at first. But don’t give up! Take it slow and easy, and listen to your body. Some mild pain is normal during or after the first few times you do yoga stretches. If pain is severe, stop the movement.

Some forms of yoga are more intensive than others. For example, Bikram yoga is practiced in a heated, humid room. Ashtanga yoga and Vinyasa yoga are more fast-paced. If you’re considering taking a yoga class, you may want to start with Hatha yoga. This type is slower-paced and concentrates on stretching. Before trying yoga to treat AS, you should consult with your doctor.



Combo Therapy Slows Progression in Ankylosing Spondylitis

The progression of ankylosing spondylitis can be slowed when tumor necrosis factor (TNF) inhibitors are added to high-dose nonsteroidal anti-inflammatory drugs (NSAIDs), possibly because of a synergistic effect between the two drugs, according to new research.

“This is the first study to show a relation between these drugs, and the first long-term longitudinal cohort study looking at drug effects on progression,” said investigator Lianne Gensler, MD, director of the Ankylosing Spondylitis Clinic at the University of California, San Francisco Medical Center.

She presented the research here at the International Congress on Spondyloarthritides 2016.

All 527 patients had ankylosing spondylitis with at least 2 years of clinical and radiographic imaging follow-up. Mean follow-up was 3.67 years.

Disease progression was defined as an increase of at least 2 units on the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) over 24 months.

The propensity-score analysis was adjusted for factors such as disease duration, sex, race, education level, comorbidities, smoking, C-reactive protein levels, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, and baseline mSASSS.

Of the 42% of patients who used TNF inhibitors in the first interval of the study, 10% had a high NSAID-use index. Of the 58% of patients who did not use TNF inhibitors, 20% had a high NSAID-use index.

After multivariate adjustment, the probability of radiographic progression was lower for patients with a high NSAID-use index who used TNF inhibitors than for those who did not use TNF inhibitors; in fact, the reduction was much as 70% (odds ratio, 0.30; P = .05).

For patients with a low NSAID-use index or no NSAID use, rates of radiographic progression were not significantly different between users and nonusers of TNF inhibitors.

The combination of TNF inhibitors and NSAIDs is typically not recommended for patients with ankylosing spondylitis, Dr Gensler told Medscape Medical News. However, in some cases, symptoms dictate the combination, and in other cases, overlap can occur during the course of treatment.

“Patients are expected to try a course of NSAIDs before stepping up to a TNF inhibitor, and they are often on both in the initial stage of starting the TNF inhibitor,” she explained. “Most will stop or taper the NSAID when symptoms are controlled.”

The mechanism of the synergistic effect between the two drugs could be related to a combined anti-inflammatory effect, Dr Gensler speculated.

“NSAIDs have been used to prevent heterotrophic ossification in surgical patients for years, and TNF inhibitors obviously suppress inflammation and promote the repair of erosions,” she explained. “It is possible that together they optimize control of inflammation and prevent new bone both directly and indirectly.”

The effects of these drugs on disease modification and the progression of ankylosing spondylitis are a matter of debate. Clinical trials of TNF inhibitors have shown no effect on progression; however, Dr Gensler was involved in a previous study that showed evidence of a protective effect of TNF inhibitors (Arthritis Rheum. 2013;65:2645–2654).

Although the current study is the first to show a combined effect of NSAIDs and TNF inhibitors on disease progression, Dr Gensler said that longer-term studies are needed.

“This study implies a causal relation; however, unmeasured confounders are possible,” she said. Still, it does start “to give a more granular look at the potential benefit, aided by the power in the numbers — both of patients and in follow-up time.”

“Additional analyses need to be done, and validation in another cohort — or better, in a randomized controlled trial — to examine the relation would be optimal,” she added.

For the moment, I would say this looks more like residual confounding than a true effect.

“It’s hard to say whether this reflects a real effect,” said Robert Landewé, MD, professor of rheumatology at the Amsterdam Rheumatology & Immunology Center, who is copresident of the meeting.

“For the moment, I would say this looks more like residual confounding than a true effect,” he told Medscape Medical News. Nevertheless, the study contributes an intriguing theory for discussion, Dr Landewé said.

“There has been ongoing discussion about whether TNF inhibitors inhibit radiographic progression, and this brings another nuance of the story,” he explained. “I have not seen this in previous studies. It’s a new angle in the discussion and it’s very interesting.”




Unexplained Lower Back Pain? It Could Be Ankylosing Spondylitis

Lower back pain is common and many of those who have suffered it can identify, or at least guess, the event that led to their back injury. Perhaps it was weekend sport or a garden project. Often a trip to the GP or physiotherapist will confirm suspicions and a suitable treatment regime follows.

For others, the cause is less certain. Roughly a quarter of patients under 45 years suffering ongoing lower-back pain (three months or more) without an obvious other cause will have the disease ankylosing spondylitis. This somewhat daunting name essentially means “fused and inflamed spine”.

Ankylosing spondylitis is quite different to other forms of lower back pain: it is not a result of mechanical or muscular injury.

Ankylosing spondylitis is a disease of chronic, inappropriate inflammation. In much the same way as other autoimmune diseases (such as rheumatoid arthritis or type 1 diabetes), sustained inflammation leads to tissue damage and a reduction in normal function.

A and B show side-on and front-to-back views of the lumbar spine in a patient without ankylosing spondylitis. C and D show the lumbar spine in a patient with ankylosing spondylitis ‘bamboo spine’. Note the bone joining (‘ankylosing’) the vertebrae together (arrowed). Author provided

A stark example in patients with severe ankylosing spondylitis is “bamboo spine”, the disturbingly vivid name for fused vertebrae; joined as a result of inflammation-induced bone growth.

Patients with less dramatic ankylosing spondylitis symptoms can still suffer terribly, and the impact on everyday activities and routine tasks can be quite major. Friendships, family relationships and sexual activity can all be affected as a result of fatigue, stiffness and pain.

The most common symptoms are chronic lower back pain and stiffness, often waking sufferers during the night, and typically being worse in the mornings. Alternating buttock pain is also a common sign.

People with ankylosing spondylitis can additionally experience pain and stiffness in their shoulders, chest, upper back, hips, knees and feet, and the disease can affect other organs, commonly the eyes.

In Australia, about 0.5% of the population suffer from ankylosing spondylitis and it is more commonly diagnosed in men; up to three times more often.

Ankylosing spondylitis is a serious disease and left untreated it can lead to prolonged suffering and permanent changes of the spine. The symptoms of ankylosing spondylitis appear gradually, usually when patients are in their late teens or early 20s.


There is no cure for ankylosing spondylitis, but there are good management options, especially when patients are diagnosed early in the course of the disease and the destructive inflammation can be restrained. But herein lies the problem: a sizeable fraction of people with ankylosing spondylitis are only finally diagnosed after the disease has wreaked considerable damage.

It is not uncommon for ankylosing spondylitis patients to endure a decade between disease onset and definitive diagnosis, living with a great deal of hardship in the meantime. This is because chronic back pain is common in the community, and often caused by conditions other than ankylosing spondylitis, so the correct diagnosis is often overlooked.

Ankylosing spondylitis patients with more advanced forms of the disease will not only face reduced physical capacity and a decline in general well-being, they will also be much less responsive to treatment, because of the damage the disease has already caused to their spines.

The possibility of ankylosing spondylitis needs to be in the mind of GPs and physiotherapists when managing younger patients with persistent lower-back pain. Most of these patients won’t have ankylosing spondylitis, but a significant proportion do, and it’s important they are diagnosed correctly.

Increasing awareness of ankylosing spondylitis, and the appropriate care pathways, should be a priority of ongoing professional training.

Public awareness campaigns also have a role, such as the availability of online screening tools for back pain sufferers to assess the chances their own problems are due to ankylosing spondylitis. If ankylosing spondylitis is suspected, patients can be referred to a rheumatologist and, if a diagnosis of ankylosing spondylitis is made, management can start early.


There are good treatment options for relieving the pain of ankylosing spondylitis sufferers. Current management includes patient education about the condition, how it may affect patients, and what sufferers can do to help themselves deal with the disease. Lifestyle adjustments such as changes to work patterns, a specific exercise program, and appropriate drugs can all be effective.

Most ankylosing spondylitis patients respond well to non-steroidal anti-inflammatory drugs, showing a reduction in both pain and inflammation. Those who don’t respond to non-steroidal anti-inflammatory drugs can often experience positive outcomes when treated with tumour necrosis factor inhibitor drugs.

These medications block tumour necrosis factor, a protein that is one of the main causes of inflammation in ankylosing spondylitis, and greatly reduce pain and other ankylosing spondylitis associated symptoms.

The most important thing is that health-care professionals become more aware of this disease so it doesn’t take so long to diagnose. With early diagnosis, treatment will be more effective, and sufferers can look forward to getting on with their lives.