What Is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a form of arthritis that affects the joints in the spine. Its name comes from the Greek words ankylos, meaning stiffening of a joint, and spondylo, meaning vertebra. Spondylitis causes inflammation (redness, heat, swelling, and pain) in the spine or vertebrae. AS often involves an inflamed sacroiliac (SI) joint, where the spine joins the pelvis.

In some people, the condition can affect other joints. The shoulders, ribs, hips, knees, and feet can be affected. It can also affect places where the tendons and ligaments attach to the bones. Sometimes it can affect other organs such as the eyes, bowel, and very rarely, the heart and lungs.

Many people who have AS have mild back pain that comes and goes. Others have severe, ongoing pain. Sometimes they lose flexibility in the spine. In the most severe cases, the swelling can cause two or more bones of the spine to fuse. This may stiffen the rib cage, restricting lung capacity.


AS usually begins in the teen or young adult years. Most people who have the disease get symptoms before age 30. Only five percent get symptoms after age 45. It affects people for the rest of their lives. And it affects about twice as many men as women.

What Causes Ankylosing Spondylitis?

The cause of AS is unknown. It’s likely that genes (passed from parents to children) and the environment both play a role. The main gene associated with the risk for AS is called HLA-B27. Having the gene doesn’t mean you will get AS. Fewer than 1 of 20 people with HLA-B27 gets AS. Scientists recently discovered two more genes (IL23R and ERAP1) that, along with HLA-B27, carry a genetic risk for AS.

How Is Ankylosing Spondylitis Diagnosed?

To diagnose AS, your doctor will need:

A medical history
A physical exam
X rays or MRIs
Blood tests.
What Type of Doctor Diagnoses and Treats Ankylosing Spondylitis?

Often, a rheumatologist will diagnose AS. This is a doctor trained to treat arthritis and related conditions. Because AS can affect different parts of your body, you may need to see more than one doctor. Some other types of doctors who treat the symptoms of AS are:

An ophthalmologist, who treats eye disease.
A gastroenterologist, who treats bowel disease.
A physiatrist, who specializes in physical medicine and rehabilitation.
A physical therapist, who provides stretching and exercise regimens.
Can Ankylosing Spondylitis Be Cured?

There is no cure for AS. Some treatments relieve symptoms and may keep the disease from getting worse. In most cases, treatment involves medicine, exercise, and self-help measures. In some cases, surgery can repair some joint damage.

What Medicines Are Used to Treat Ankylosing Spondylitis?

Several types of medicines are used to treat AS. It is important to work with your doctor to find the safest and most effective medication for you. Medicines for AS include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs relieve pain and swelling. Aspirin, ibuprofen, and naproxen are examples of NSAIDs.
Corticosteroids. These strong drugs are similar to the cortisone made by your body. They fight inflammation.
Disease-modifying antirheumatic drugs (DMARDs). These drugs work in different ways to reduce inflammation in AS.
Biologic agents. These are relatively new types of medicine. They block proteins involved with inflammation in the body.
Will Diet and Exercise A healthy diet and exercise are good for everyone, and they may be very helpful if you have AS. There is no specific diet for people with AS, but keeping a healthy weight is important. It reduces stress on painful joints. Omega-3 fatty acids, found in coldwater fish (such as tuna and salmon), flax seeds, and walnuts, might reduce disease activity. This is still being studied.

Exercise and stretching may help painful, stiff joints. It should be done carefully and increased gradually. Before beginning an exercise program, it’s important to speak with a doctor who can tailor exercises to your needs. Two types of exercises may help:

Strengthening exercises
Range-of-motion exercises.
Many people with AS find it helpful to exercise in water.

Will Surgery Be Necessary?

If AS causes joint damage that makes daily activities difficult, joint replacement may be an option. The most commonly replaced joints are the knee and hip.

In very rare cases, surgery to straighten the spine may be recommended. This can only be done by a surgeon with quite a lot of experience in the procedure.

What Can I Do to Help Myself?

These are important things you can do:

See your doctor regularly.
Follow your prescribed treatment plan.
Stay active with regular exercise.
Practice good posture.
Don’t smoke.
What Research Is Being Done on Ankylosing Spondylitis?

Researchers are seeking a better understanding of AS. They are studying:

Lifestyle and other factors that lead to better or worse outcomes.
Genes associated with AS risk.
Development of blood tests to predict AS risk or to aid in early diagnosis.
New drug therapies for AS.

Creative chocolates

Many of the old myths about chocolate and health and crumbling under the weight of scientific fact. The once-prevalent believe that something that tastes so good just can't be good for you has given way to a more balanced picture of chocolate and cocoa products and their relation to health and nutrition. Here are brief reviews of recent findings that correct common mis perceptions of the effects of chocolate on health.

Myth: Confectionery is a major cause of tooth decay.

Truth: Tooth decay is primarily the result of poor oral hygiene. Dental caries (another word for cavities) are caused by any foods containing ferment able carbohydrates that are left on the teeth for too long. In fact, there are ingredients found in chocolate products that may retard the tooth decaying process.

 

Myth: Chocolate is high in caffeine.

Truth: The amount of caffeine in a piece of chocolate candy is significantly lower than that in coffee, tea or cola drinks. For instance, a 5 oz cup of instant coffee has between 40 and 108 mg of caffeine, while a 1 oz milk chocolate bar contains only 6 mg and many confectionery items have no caffeine at all.

 

Myth: Confectionery has a high fat content and will lead to weight gain.

Truth: "Candy, in moderation, can be part of low-fat eating. In fact, an occasional sweet treat helps you stick to a healthy eating plan." - Annette B. Natow, Ph.D., R.D., author of The Fat Counter and The Fat Attack Plan.

 

Cholesterol

Q. What is the level of cholesterol in a 1.65 oz. bar of milk chocolate?

A. The American Heart Association recommends that daily cholesterol intake not exceed 300 mg. A chocolate bar is actually low in cholesterol. A 1.65 oz. bar contains only 12 mg! A one oz piece of cheddar cheese contains 30 mg of cholesterol — more than double the amount found in a chocolate bar.

 

Sodium

Q. What is the level of sodium in a one oz milk chocolate bar?

A. According to the National Research Council of the National Academy of Sciences, the maximum Recommended Daily Allowance (RDA) for sodium is 1,100 to 3,300 mg daily. A 1.5 oz milk chocolate bar contains 41 mg, while the same size dark chocolate bar contains only 5 mg On the other hand, a 1.5 oz serving of iced devil's food cake has a whopping 241 mg — many times more than chocolate bars.

 

Fat

Q. How much fat is there in a 1.5 oz. chocolate bar?

A. Health professionals and nutritionists suggest that calories from fat should account for no more than 30% of your daily caloric intake. A 1.5 oz. milk chocolate bar contains 13 grams of fat; a dark chocolate bar of the same weight contains 12.

 

Acne: No Link to Chocolate

Over the past two decades, clinical studies have exonerated chocolate as a cause or exacerbating factor in the development or persistence of acne. In fact, many dermatologists doubt that diet plays any significant role in acne.

 

At the University of Missouri, student volunteers with mild to moderate acne each consumed nearly 20 ounces of chocolate over a 48 hour period. Examination of lesions on the fifth day of the test and again on the seventh day showed no new lesions other than those that might be expected based upon the usual variations the subjects had exhibited during several weeks of observation prior to the test.

 

In a research study at the University of Pennsylvania School of Medicine, a group of 65 subjects were fed chocolate bars containing nearly ten times the amount of chocolate liquor as a normal 1.5 oz commercially available chocolate bar. A control group ate a bar that tasted like chocolate, but actually contained no chocolate liquor. At the conclusion of the test, the average acne condition of those eating the chocolate was virtually identical to that of the controls, who had eaten the imitation bars.

 

Chocolate and Allergy

It is possible for a person to be allergic to any food, including chocolate. But recent evidence suggests that allergy to chocolate may be relatively rare.

 

The actual incidence of allergic sensitivity to chocolate is far less common than positive reactions to skin scratch tests would seem to indicate. In at least one double-blind study to determine the correlation positive skin tests for chocolate allergy and the manifestation of clinically observable symptoms, researchers could find only one patient out of a possible 500 who showed both a positive response to the skin test and an objective clinical reaction after eating chocolate.

 

To confirm food allergy or food sensitivity, a "challenge" of the food in question is administered. To yield accurate results, the challenge should be conducted under double-blind conditions; that is, neither the investigator nor the patient knows in advance whether the food administered is the suspected substance or a placebo. This allows for objective evaluation of clinical symptoms.

 

According to S. Allan Bock, M.D., a researcher in food allergy at the National Jewish Center for Immunology and Respiratory Medicine, evaluation of hundreds of patients at that institution has shown no confirmed allergic reaction to chocolate during double-blind challenges.

 

Caffeine and Theobromine

Caffeine and theobromine belong to a group of substances known as methylxanthines. Caffeine occurs naturally in coffee, tea, cola and, to some degree, cocoa beans. It may also be added to cola drinks and is a component of certain over-the- counter and prescription medications. Theobromine is found in cocoa beans; tea contains trace amounts.

 

Caffeine

The amount of caffeine ingested when people eat chocolate in normal quantities is very small. One ounce of milk chocolate, for example, contains 6 mg of caffeine, little more than the amount found in a cup of decaffeinated coffee. Moreover, there have been no reports in the scientific literature of any health problems among children or adults as a result of the caffeine consumed in chocolate.

 

Theobromine

Although theobromine is chemically related to caffeine, it lacks caffeine's stimulant effect on the central nervous system (CNS). In fact, theobromine is virtually inert as a CNS stimulant.

 

Despite the weakness of theobromine's effect on the brain, many people have mistakenly assumed that it is effective in warding off fatigue and sleep, especially when it is consumed in combination with caffeine, as in chocolate.

 

To test this assumption, researchers compared the effect of caffeine, theobromine and a placebo in a clinical study. They found that theobromine administered in a dose of 500 mg (the amount of theobromine in approximately 11 oz of milk chocolate consumed in one sitting) did not increase pulse rate significantly more than the placebo. Caffeine, when compared to theobromine and the placebo, produced significant CNS stimulation.

 

In a double-blind clinical study, subjects ingested measured quantities of caffeine and theobromine, separately and together, at random. Caffeine altered the subjects' own estimates of the time it took to fall asleep, as well as the soundness of sleep, in a dose-dependent fashion. A dose of 300 mg. of theobromine, however, had no detectable effect on sleep. When administered in combination with caffeine, theobromine neither increased nor decreased the sleep effects of caffeine.

 

Dental Caries

Tooth decay has become less of a problem for American children over the last 25 years. Between 1960 and 1980 the incidence of cavities dropped by 50%. Today, one-third of all Americans of college age have never had a single cavity, thanks largely to fluoride delivered in water systems, toothpastes and professional fluoride treatments.

 

Fluoride, good oral hygiene, and professional check-ups and prophylactic treatments are keys to minimizing the incidence of tooth decay. Diet is another factor.

 

It is widely accepted that all foods containing "fermentable carbohydrate" have the potential to contribute to caries formation. Fermentable carbohydrate is present in most starches and all sugars, including those that occur naturally in foods and those added in processed foods. The frequency and duration of tooth exposure to fermentable carbohydrate have been identified as a factor in caries.

 

Although chocolate contains fermentable carbohydrates, a number of dental research studies suggest that chocolate may be less apt to promote tooth decay than has been traditionally believed.

 

Research at the Forsyth Dental Center in Boston has shown that chocolate has the ability to offset the acid-producing potential of the sugar it contains. Acid, produced by certain oral bacteria that digest, or "ferment", sugars, may damage tooth enamel and cause decay.

 

Other theories have been advanced to explain the fact that chocolate appears to be less cariogenic (cavity-producing) than its fermentable carbohydrate content would seem to indicate. In a study conducted at the Eastman Dental Center, certain chocolate products tested were found to be among the snack foods contributing least to tooth decay. The researchers reported that milk chocolate's protein, calcium and phosphate content may provide protective effects on tooth enamel. In addition, because of its natural fat content, chocolate clears the mouth relatively faster than other confections; this is important because the time fermentable carbohydrate remains n contact with tooth surfaces has a bearing on the food's cariogenic potential.

 

Weight Control

Contrary to popular stereotype, most overweight people do not eat excessive amounts of cake, cookies, confections or other foods containing sugar. Their sugar intake tends, in fact, to be below average.

 

More important in controlling weight is the total number of calories consumed each day and the amount of energy expended in physical activity. Overweight children, for example, are generally less active than those of normal weight; thus, they may remain obese even when their caloric intake is reasonable or even limited.

 

Moreover, many people overestimate the calories in chocolate. A 1.5 oz milk chocolate bar contains approximately 220 calories, low enough to incorporate into a weight control diet. The occasional chocolate confection may also reduce the possibility of severe bingeing, which can occur as a result of feeling deprived of highly satisfying foods such as chocolate.