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ankylosing_spondylitis [2018/03/14 08:02] (current)
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 +[[Ayurveda Dharma]] is distributed [[copyleft]] via this [[GNU Free Documentation License]] (FDL) and/or under [[Creative Commons License]] Attribution-Share Alike 3.0 United States: http://​creativecommons.org/​licenses/​by-sa/​3.0/​us/​legalcode. ​ Since words create our reality (see [[prajna]]),​ there are certain words to avoid: Please see also: [[Words to Avoid]]
 +----
 +
 +Ankylosing Spondylitis
 +
 +This is a chronic inflammatory arthritis that commonly affects the sacroiliac joints in young men. The onset is usually rapid with recurring episodes of low back pain and stiffness, which radiates sometimes to buttocks or thighs. Characteristically,​ the symptoms are worse in the early morning and following inactivity. Ayurvedic treatment involves detoxification and elimination of toxins and the prescription of the right diet, lifestyle and herbal preparations.
 +
 +[[Fair Use]] Source: http://​www.jiva.com/​ayurveda/​treatment/​problems-we-treat/​207.html?​task=view
 +
 +http://​www.ayurveda-california.com/​distance_learning/​index.php/​diseases-treatment-with-ayurveda-chinese-medicine/​ankylosing-spondylitis
 +----
 +
 +
 +Ankylosing spondylitis
 +From Wikipedia, the free encyclopedia
 +Jump to: navigation, search
 +Ankylosing spondylitis
 +Classification and external resources
 +ICD-10 M08.1, M45.
 +ICD-9 720.0
 +OMIM 106300
 +DiseasesDB 728
 +MedlinePlus 000420
 +eMedicine radio/​41 ​
 +MeSH D013167
 +
 +Ankylosing spondylitis (AS; previously known as Bechterew'​s disease, Bechterew syndrome, Marie Strümpell disease), a form of Spondyloarthritis is a chronic, painful, inflammatory arthritis primarily affecting spine and sacroiliac joints, causing eventual fusion of the spine; it is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine.[1]
 +Contents
 +[hide]
 +
 +    * 1 Signs and symptoms
 +    * 2 Causes
 +    * 3 Pathophysiology
 +    * 4 Pathophysiology
 +    * 5 Diagnosis
 +    * 6 Prevention
 +    * 7 Treatment
 +          o 7.1 Medication
 +          o 7.2 Surgery
 +          o 7.3 Physical therapy
 +    * 8 Prognosis
 +    * 9 Epidemiology
 +    * 10 History
 +    * 11 Research directions
 +    * 12 See also
 +    * 13 References
 +    * 14 External links
 +          o 14.1 Diagnostic tools
 +
 +[edit] Signs and symptoms
 +
 +The typical patient is young, aged 18-30, with chronic pain and stiffness in the lower part of the spine, often with pain referred to one or other buttock or back of thigh from the sacroiliac joint early on. Pain is often severe on rest, and improves with physical activity. Men are affected more than women by a ratio about of 3:1.[2] In 40% of cases, ankylosing spondylitis is associated with iridocyclitis causing eye pain and photophobia. Another common symptom is generalised fatigue. Less commonly aortitis, apical lung fibrosis and ectasia of the sacral nerve root sheaths may occur. As with all the seronegative spondarthropathies,​ lifting of the nails (onycholysis) may occur.
 +
 +When the condition presents before the age of 18 it is relatively likely to cause pain and swelling of large limb joints, particularly the knee. The spine may be affected on later.
 +
 +AS is one of a cluster of conditions known as seronegative spondarthropathies in which the characteristic pathological lesion is an inflammation of the enthesis (the insertion of tensile connective tissue into bone). Other forms of spondarthropathy area associated with ulcerative colitis, Crohn'​s disease, psoriasis, and Reiter'​s syndrome.
 +
 +[edit] Causes
 + Please help improve this section by expanding it. Further information might be found on the talk page.
 +
 +[edit] Pathophysiology
 +The ankylosis process.
 +
 +AS is a systemic rheumatic disease and is one of the seronegative spondyloarthropathies. About 90% of the patients express the HLA-B27 genotype. Tumor necrosis factor-alpha (TNF α) and IL-1 are also implicated in ankylosing spondylitis. Specific autoantibodies have not been detected and it is therefore probably not appropriate to consider it an autoimmune disease.
 +
 +The association of AS with HLA-B27 and the absence of any autoantibodies suggests that the condition is due to overactivity of CD8 T cells, which interact with HLA-B. There is no evidence that this interaction involves a self antigen and at least in the related Reiter'​s syndrome, which follows infections, the antigens involved are likely to be derived from intracellular microorganisms. There is, however, a possibility that CD4 T cells are involved in an aberrant way, since HA-B27 appears to have a number of unusual properties, including possibly an ability to interact with T cell receptors in association with CD4.
 +
 +There has been a longstanding claim that AS arises from a cross-reaction between HLA-B27 and antigens of the Klebsiella bacterial strain (Tiwana et al. 2001).[3]The problem with this idea is that no such cross reactivity with B27 has been found (I.e. although antibody responses to klebsiella may be increased there is no antibody response to B27, so there seems to be no cross reactivity.) Particular authorities argue that elimination of the prime nutrients of Klebsiella (starches) would decrease antigenemia and improve the musculoskeletal symptoms. However, as Khan (2002) argues, evidence for a correlation between Klebsiella and AS is circumstantial so far, and that the efficacy of low-starch diets has not yet been scientifically evaluated.[4] Similarly, Toivanen (1999) found no support for the role of klebsiella in the etiology of primary AS.[5]
 +
 +[edit] Pathophysiology
 +
 +AS is a systemic rheumatic disease and is one of the seronegative spondyloarthropathies. About 90% of the patients express the HLA-B27 genotype. Tumor necrosis factor-alpha (TNF α) and IL-1 are also implicated in ankylosing spondylitis. Specific autoantibodies have not been detected and it is therefore probably not appropriate to consider it an autoimmune disease.
 +
 +The association of AS with HLA-B27 and the absence of any autoantibodies suggests that the condition is due to overactivity of CD8 T cells, which interact with HLA-B. There is no evidence that this interaction involves a self antigen and at least in the related Reiter'​s syndrome, which follows infections, the antigens involved are likely to be derived from intracellular microorganisms. There is, however, a possibility that CD4 T cells are involved in an aberrant way, since HA-B27 appears to have a number of unusual properties, including possibly an ability to interact with T cell receptors in association with CD4.
 +
 +There has been a longstanding claim that AS arises from a cross-reaction between HLA-B27 and antigens of the Klebsiella bacterial strain (Tiwana et al. 2001).[6]The problem with this idea is that no such cross reactivity with B27 has been found (I.e. although antibody responses to klebsiella may be increased there is no antibody response to B27, so there seems to be no cross reactivity.) Particular authorities argue that elimination of the prime nutrients of Klebsiella (starches) would decrease antigenemia and improve the musculoskeletal symptoms. However, as Khan (2002) argues, evidence for a correlation between Klebsiella and AS is circumstantial so far, and that the efficacy of low-starch diets has not yet been scientifically evaluated.[7] Similarly, Toivanen (1999) found no support for the role of klebsiella in the etiology of primary AS.[8]
 +
 +[edit] Diagnosis
 +Lateral Lumbar Spine X-Ray demonstrating Ankylosing spondylitis
 +
 +There is no direct test to diagnose AS. A clinical examination and X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis,​ are the major diagnostic tools. A drawback of X-ray diagnosis is that signs and symptoms of AS have usually been established as long as 8-10 years prior to X-ray-evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced. Options for earlier diagnosis are tomography and magnetic resonance imaging of the sacroiliac joints, but the reliability of these tests is still unclear. The Schober'​s test is a useful clinical measure of flexion of the lumbar spine performed during examination.[9]
 +
 +During acute inflammatory periods, AS patients will usually show an increase in the blood concentration of C-reactive protein (CRP) and an increase in the erythrocyte sedimentation rate (ESR).
 +
 +Variations of the HLA-B gene increase the risk of developing ankylosing spondylitis,​ although it is not a diagnostic test. Those with the HLA-B27 variant are at a higher risk than the general population of developing the disorder. HLA-B27, demonstrated in a blood test, can occasionally help with diagnosis but in itself is not diagnostic of AS in a person with back pain. Over 95% of people that have been diagnosed with AS are HLA-B27 positive, although this ratio varies from population to population (only 50% of African American patients with AS possess HLA-B27, and it is close to 80% among AS patients from Mediterranean countries). In early onset disease HLA-B7/​B*2705 heterozygotes exhibited the highest risk for disease.[10]
 +
 +In 2007, a collaborative effort by an international team of researchers in the U.K., Australia and the United States led to the discovery of two genes, ARTS1 and IL23R, that also contribute to the cause of AS. The findings were published in the November 2007 edition of Nature Genetics, a journal that emphasizes research on the genetic basis for common and complex diseases.[11] Together with HLA-B27, these two genes account for roughly 70 percent of the overall incidence of the disease.
 +
 +The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), developed in Bath (UK), is an index designed to detect the inflammatory burden of active disease. The BASDAI can help to establish a diagnosis of AS in the presence of other factors such as HLA-B27 positivity, persistent buttock pain which resolves with exercise, and X-ray or MRI evident involvement of the sacroiliac joints. (See: "​Diagnostic Tools",​ below)[12] It can be easily calculated and accurately assesses a patient'​s need for additional therapy; a patient with a score of 4 out of a possible 10 points while on adequate NSAID therapy is usually considered a good candidate for biologic therapy.
 +
 +The Bath Ankylosing Spondylitis Functional Index (BASFI) is a functional index which can accurately assess a patient'​s functional impairment due to the disease as well as improvements following therapy. (See: "​Diagnostic Tools",​ below)[13] The BASFI is not usually used as a diagnostic tool but rather as a tool to establish a patient'​s current baseline and subsequent response to therapy.
 +
 +[edit] Prevention
 + Please help improve this section by expanding it. Further information might be found on the talk page.
 +
 +[edit] Treatment
 +
 +No cure is known for AS, although treatments and medications are available to reduce symptoms and pain.
 +
 +Physical therapy and exercise, along with medication, are at the heart of therapy for ankylosing spondylitis. Physiotherapy and physical exercises are clearly to be preceded by medical treatment in order to reduce the inflammation and pain and are commonly followed by a physician. This way the movements will help in diminishing pain and stiffness, while exercise in an active inflammatory state will just make the pain worse.
 +
 +Medical professionals and experts in AS have widely speculated that maintaining good posture can reduce the likelihood of a fused or curved spine which occurs in a significant percentage of diagnosed persons. [14][15]
 +
 +[edit] Medication
 +
 +There are three major types of medications used to treat ankylosing spondylitis.
 +
 +    * Anti-inflammatory drugs, which include NSAIDs such as aspirin, ibuprofen, phenylbutazone,​ indomethacin,​ naproxen and COX-2 inhibitors, which reduce inflammation,​ and consequently pain. These drugs tend to have a personal response to the pain and inflammation,​ although commonly used anti-inflammatory drugs like nimesulide are less effective than others. Opioid analgesics have also been proven by clinical evidence to be very effective in alleviating the type of chronic pain commonly experienced by those suffering from AS, especially in low dose time-release formulations. While NSAIDs should generally be tried first, the use of opioid analgesics either apart from or in concert with NSAIDs should not be summarily dismissed for fear of addiction, as studies have shown that patients who properly take opioid analgesics for pain rarely suffer from addiction as a result of using such opioid therapy for pain relief purposes.
 +    * DMARDs such as cyclosporin,​ methotrexate,​ sulfasalazine,​ and corticosteroids,​ used to reduce the immune system response through immunosuppression;​
 +    * TNFα blockers (antagonists) such as etanercept, infliximab and adalimumab (also known as biologics), are indicated for the treatment of and are effective immunosuppressants in AS as in other autoimmune diseases;
 +
 +TNFα blockers have been shown to be the most promising treatment, slowing the progress of AS in the majority of clinical cases. They have also been shown to be highly effective in treating not only the arthritis of the joints but also the spinal arthritis associated with AS. A drawback is the fact that these drugs increase the risk of infections. For this reason, the protocol for any of the TNF-α blockers include a test for tuberculosis (like Mantoux or Heaf) before starting treatment. In case of recurrent infections, even recurrent sore throats, the therapy may be suspended because of the involved immunosuppression.
 +
 +[edit] Surgery
 +
 +In severe cases of AS, surgery can be an option in the form of joint replacements,​ particularly in the knees and hips. Surgical correction is also possible for those with severe flexion deformities (severe downward curvature) of the spine, particularly in the neck, although this procedure is considered risky.
 +
 +In addition, AS can have some manifestations which make anaesthesia more complex.
 +
 +Changes in the upper airway can lead to difficulties in intubating the airway, spinal and epidural anaesthesia may be difficult owing to calcification of ligaments, and a small number have aortic regurgitation. The stiffness of the thoracic ribs results in ventilation being mainly diaphragm-driven,​ so there may be a decrease in pulmonary function.
 +
 +[edit] Physical therapy
 +
 +All physical therapies must be approved in advance by a rheumatologist,​ since movements that normally have great benefits to one's health may harm a patient with AS; massages and physical manipulations should be practiced by therapists familiar with this disease. Some of the therapies that have been shown to benefit AS patients include:
 +
 +    * Physical therapy/​Physiotherapy,​ shown to be of great benefit to AS patients;
 +    * Swimming, one of the preferred exercises since it involves all muscles and joints in a low gravity environment;​
 +    * Slow movement muscle extending exercises like stretching, yoga, tai chi, Pilates method, etc.
 +
 +Moderate-to-high impact exercises like jogging are generally not recommended or recommended with restrictions due to the jarring of affected vertebrae that can worsen pain and stiffness in some patients.
 +
 +
 +[edit] Prognosis
 +
 +AS can range from mild to progressively debilitating and from medically controlled to refractive.
 +
 +Unattended cases of AS normally lead to knee pain and may be accompanied by dactylitis or enthesitis, which may result in a misdiagnosis of normal rheumatism. In a long-term undiagnosed period, osteopenia or osteoporosis of the AP spine may occur, causing eventual compression fractures and a back "​hump"​ if untreated. Typical signs of progressed AS are the visible formation of syndesmophytes on X-rays and abnormal bone outgrowths similar to osteophytes affecting the spine. The fusion of the vertebrae paresthesia is a complication due to the inflammation of the tissue surrounding nerves.
 +
 +Organs commonly affected by AS, other than the axial spine and other joints, are the heart, lungs, colon, and kidney. Other complications are aortic regurgitation,​ Achilles tendinitis, AV node block and amyloidosis.[16] Owing to lung fibrosis, chest X-rays may show apical fibrosis while pulmonary function testing may reveal a restrictive lung defect. Very rare complications involve neurologic conditions such as the cauda equina syndrome.[17][16]
 +
 +[edit] Epidemiology
 +
 +The sex ratio is 3:1 for men:women. the prevalence is 0.25%, but as it is a chronic condition the incidence (number of new cases) is fairly low. Many rheumatologists believe the number of women with AS is underdiagnosed,​ as women tend to manifest symptoms in their neck/​shoulders/​upper chest and peripheral joints instead of their lower spinal area (lumbar, sacrum, hips, pelvis), where the first symptoms appear in male patients. [18].
 +
 +[edit] History
 +Leonard Trask, the Wonderful Invalid.
 +
 +It has been suggested that AS was first recognized as a disease which was different from rheumatoid arthritis by Galen as early as the second century A.D.[19]; however, skeletal evidence of the disease (ossification of joints and entheses primarily of the axial skeleton, known as "​bamboo spine"​) was first discovered in an archaeological dig that unearthed the skeletal remains of a 5000-year–old Egyptian mummy with evidence of "​bamboo spine"​.[20]
 +
 +The anatomist and surgeon Realdo Colombo described what could have been the disease in 1559,[21] and the first account of pathologic changes to the skeleton possibly associated with AS was published in 1691 by Bernard Connor.[22] In 1818, Benjamin Brodie became the first physician to document that a patient believed to have active AS had accompanying iritis.[23] In 1858, David Tucker published a small booklet which clearly described a patient by the name of Leonard Trask who suffered from severe spinal deformity subsequent to AS.[24][25] In 1833 Trask fell from a horse, exacerbating the condition and resulting in severe deformity. Tucker reported:
 +“ It was not until he [Trask] had exercised for some time that he could perform any labor [..., and that] his neck and back have continued to curve drawing his head downward on his breast. ”
 +
 +This account became the first documented case of AS in the United States, since its indisputable description of inflammatory disease characteristics of AS, and the hallmark of deforming injury in AS.
 +
 +It was not until the late nineteenth century (1893-1898),​ however, when the neurophysiologist Vladimir Bekhterev of Russia in 1893,[26] Adolph Strümpell of Germany in 1897,[27] and Pierre Marie of France in 1898,[28] were the first to give adequate descriptions which permitted an accurate diagnosis of AS prior to severe spinal deformity. For this reason, AS is also known as Bechterew Disease or Marie–Strümpel Disease.
 +
 +[edit] Research directions
 + Please help improve this section by expanding it. Further information might be found on the talk page. (January 2009)
 +
 +The majority of patients with AS exhibit the HLA-B27 antigen and high levels of immunoglobulin A (IgA) in the blood. The HLA-B27 antigen is also expressed by Klebsiella bacteria, which is found in high levels in the feces of AS patients. A theory suggests that the presence of the bacteria may be a trigger of the disease, and reducing the amount of starch in the diet (which the bacteria require to grow) may be of benefit to AS patients. A test of this diet resulted in reduced symptoms and inflammation in patients with AS as well as IgA levels in individuals with and without AS.[29] Further research is required to determine if diet changes may have a clinical effect on the course of the disease.
 +
 +[edit] See also
 +
 +    * NASC, North American AS federation
 +    * NIAMS, the National Institute of Arthritis and Musculoskeletal and Skin Diseases
 +    * SAA, Spondylitis Association of America
 +    * AF, Arthritis Foundation
 +
 +[edit] References
 +
 +   1. ^ Jiménez-Balderas FJ, Mintz G. (1993). "​Ankylosing spondylitis:​ clinical course in women and men". J Rheumatol 20 (12): 2069–72. PMID 7516975. ​
 +   2. ^ Merck Manual (p. 290)
 +   3. ^ Tiwana H, Natt R, Benitez-Brito R, Shah S, Wilson C, Bridger S, Harbord M, Sarner M, Ebringer A (2001). "​Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn'​s disease and ankylosing spondylitis"​. Rheumatology (Oxford) 40 (1): 15–23. doi:​10.1093/​rheumatology/​40.1.15. PMID 11157137. ​
 +   4. ^ Khan MA. (2002). Ankylosing spondylitis:​ The facts. Oxford University Press. ISBN 0-19-263282-5. ​
 +   5. ^ Toivanen P, Hansen D, Mestre F, Lehtonen L, Vaahtovuo J, Vehma M, Möttönen T, Saario R, Luukkainen R, Nissilä M (01 Sep 1999). "​Somatic serogroups, capsular types, and species of fecal Klebsiella in patients with ankylosing spondylitis"​. J Clin Microbiol 37 (9): 2808–12. PMID 10449457. http://​jcm.asm.org/​cgi/​content/​full/​37/​9/​2808?​view=long&​pmid=10449457. ​
 +   6. ^ Tiwana H, Natt R, Benitez-Brito R, Shah S, Wilson C, Bridger S, Harbord M, Sarner M, Ebringer A (2001). "​Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn'​s disease and ankylosing spondylitis"​. Rheumatology (Oxford) 40 (1): 15–23. doi:​10.1093/​rheumatology/​40.1.15. PMID 11157137. ​
 +   7. ^ Khan MA. (2002). Ankylosing spondylitis:​ The facts. Oxford University Press. ISBN 0-19-263282-5. ​
 +   8. ^ Toivanen P, Hansen D, Mestre F, Lehtonen L, Vaahtovuo J, Vehma M, Möttönen T, Saario R, Luukkainen R, Nissilä M (01 Sep 1999). "​Somatic serogroups, capsular types, and species of fecal Klebsiella in patients with ankylosing spondylitis"​. J Clin Microbiol 37 (9): 2808–12. PMID 10449457. http://​jcm.asm.org/​cgi/​content/​full/​37/​9/​2808?​view=long&​pmid=10449457. ​
 +   9. ^ Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR. (1998). "​Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care". Spine 23 (2): 343–7. doi:​10.1097/​00007632-199802010-00011. PMID 9507623. ​
 +  10. ^ Harjacek M, Margetić T, Kerhin-Brkljacić V, Martinez N, Grubić Z (2008). "​HLA-B*27/​HLA-B*07 in combination with D6S273-134 allele is associated with increased susceptibility to juvenile spondyloarthropathies"​. Clin. Exp. Rheumatol. 26 (3): 498–504. PMID 18578977. ​
 +  11. ^ Spondylitis Association of America (October 21, 2007), "​Spondylitis Association of America Participates in Study That Uncovers Two Genes Related to Disabling Form of Arthritis"​
 +  12. ^ Garrett S, Jenkinson T, Kennedy L, Whitelock H, Gaisford P, Calin A (1994). "A new approach to defining disease status in ankylosing spondylitis:​ the Bath Ankylosing Spondylitis Disease Activity Index"​. J Rheumatol 21 (12): 2286–91. PMID 7699630. ​
 +  13. ^ Calin A, Garrett S, Whitelock H, Kennedy L, O'Hea J, Mallorie P, Jenkinson T (1994). "A new approach to defining functional ability in ankylosing spondylitis:​ the development of the Bath Ankylosing Spondylitis Functional Index"​. J Rheumatol 21 (12): 2281–5. PMID 7699629. ​
 +  14. ^ "​www.arthritis.org"​. Ankylosing Spondylitis Understanding its caused, Diagnosis And Treatment.
 +  15. ^ "​Remicade.com"​. Living with Ankylosing Spondylitis. Retrieved on 2007-12-30.
 +  16. ^ a b Alpert, Joseph S. (2006). The AHA Clinical Cardiac Consult. Lippincott Williams & Wilkins. ISBN 0781764904. ​
 +  17. ^ Nicholas U. Ahn, Uri M. Ahn, Elizabeth S. Garrett et al. (2001). "Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments"​. J of Spinal Disorders 14 (5): 427–433. doi:​10.1097/​00002517-200110000-00009. PMID 11586143. ​
 +  18. ^ Patient Resources for Women, Spondylitis Association of America; retrieved May 26, 2008.
 +  19. ^ Dieppe P (1988). "Did Galen describe rheumatoid arthritis?"​. Annals of the Rheumatic Diseases 47: 84–87. doi:​10.1136/​ard.47.1.84-b. PMID 3278697. ​
 +  20. ^ Calin A. (1985). "​Ankylosing spondilitis"​. Clinics in Rheumatic Diseases 11: 41–60. ​
 +  21. ^ Pierre Marie (1995). "​Benoist M. - Historical Perspective"​. Spine 20: 849–852. ​
 +  22. ^ Blumberg BS (1958). "?"​. Arch Rheum 1: 553. doi:​10.1002/​art.1780010609. ​
 +  23. ^ Leden I (1994). "Did Bechterew describe the disease which is named after him? A question raised due to the centennial of his primary report"​. Scand J Rheumatol 23 (1): 42–5. doi:​10.3109/​03009749409102134. PMID 8108667. ​
 +  24. ^ "Life and sufferings of Leonard Trask" (PDF for registered members)). Ankylosing Spondylitis Information Matrix.
 +  25. ^ "Life and sufferings of Leonard Trask"​.
 +  26. ^ Bechterew W. (1893). "​Steifigkeit der Wirbelsaule und ihre Verkrummung als besondere Erkrankungsform"​. Neurol Centralbl 12: 426–434. ​
 +  27. ^ Strumpell A. (1897). "​Bemerkung uber die chronische ankylosirende Entzundung der Wirbelsaule und der Huftgelenke"​. Dtsch Z Nervenheilkd 11: 338–342. doi:​10.1007/​BF01674127. ​
 +  28. ^ Marie P. (1898). "Sur la spondylose rhizomelique"​. Rev Med 18: 285–315. ​
 +  29. ^ Ebringer A, Wilson C (Jan 15 1996). "The use of a low starch diet in the treatment of patients suffering from ankylosing spondylitis"​. Clin Rheumatol 15 Suppl 1: 62–66. PMID 8835506. ​
 +
 +[edit] External links
 +
 +    * Ankylosing spondylitis at the Open Directory Project
 +
 +[edit] Diagnostic tools
 +
 +    * Bath Ankylosing Spondylitis Disease Activity Index Calculator (BASDAI)
 +    * Bath Ankylosing Spondylitis Functional Index Calculator (BASFI)
 +
 +[hide]
 +v • d • e
 +Dorsopathies (M40-M54, 720-724)
 +Dorsopathies
 +spinal curvature (Kyphosis, Lordosis, Scoliosis) · Scheuermann'​s disease · Spondylolysis · Torticollis · Spondylolisthesis
 +Spondylopathies (Ankylosing spondylitis,​ Spondylosis,​ Spinal stenosis) · Schmorl'​s nodes · Degenerative disc disease · Coccydynia · Back pain (Radiculopathy,​ Neck pain, Sciatica, Low back pain)
 +
 +Retrieved from "​http://​en.wikipedia.org/​wiki/​Ankylosing_spondylitis"​
 +Categories: Arthritis | Autoimmune diseases
 +
 +Source: http://​en.wikipedia.org/​wiki/​Ankylosing_spondylitis
 +
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 +----
 +----
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 +You may also share this [[Ayurveda Dharma]] under the [[GNU Free Documentation License]] (FDL) which is in the same spirit of ([[compassionate]]) [[expedient]] sharing ([[upaya paramita]]) of ([[wisdom]]) in a generous [[dana paramita]] [[selfless]] way.
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 +----
 +Thus [[Ayurveda Dharma]] is distributed via this [[GNU Free Documentation License]] (FDL) and/or under [[Creative Commons License]] Attribution-Share Alike 3.0 United States: http://​creativecommons.org/​licenses/​by-sa/​3.0/​us/​legalcode. ​ Since words create our reality (see [[prajna]]),​ there are certain words to avoid: Please see also: [[Words to Avoid]]
 +----
 +----
 +
 +[[Fair Use]]  |  [[Credits]] ​ |  [[Dedication of Merit]] ​ |  [[Copyright]] is [[Copyleft]] ​ |  [[Disclaimers]]
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 +[[Contents]] ​ |  [[Main Page]] - Home  |  [[Caraka Samhita Modern Commentary]]
 +----
 +
 +[[Ayurvedic Distance Learning Programs]] - [[Ayurveda Correspondence Courses]]
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 +----
 +
 +[[Fundamentals of Ayurveda]] ​ |  [[Three Doshas]] ​ |  [[Vata]] ​ |  [[Pitta]] ​ |  [[Kapha]]
 +
 +[[Ayurvedic Constitutions]] ​ |  [[Vata-Pitta]] ​ |  [[Pitta-Kapha]] ​ |  [[Kapha-Vata]]
 +
 +[[Balancing Vata]] ​ |  [[Balancing Pitta]] |  [[Balancing Kapha]]
 +
 +[[Vata Diet]] ​ |  [[Pitta Diet]] ​ [[Kapha Diet]]
 +
 +[[Vata-Pitta Diet]] ​ |  [[Pitta-Kapha Diet]] ​ |  [[Tridoshic Diet]]
 +
 +[[Ten Pairs of Attributes]] ​ |  [[Five Elements]]
 +
 +[[Six Tastes]] ​ |  [[Ama]] ​ |  [[Agni]] ​ |  [[Ojas]] ​ |  [[Tejas]] ​ |  [[Prana]]
 +
 +[[Organs and Ayurveda]] ​ |  [[Dhatus]]
 +----
 +
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 +[[Ayurvedic Articles]] ​ |  [[Selected Ayurvedic Readings]] ​ |  [[Ayurvedic Research]]
 +----
 +
 +[[Legality of Ayurveda]] ​ |  [[Religion Freedom and Ayurveda]]
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 +[[National Ayurvedic Medical Associations]] ​ |  [[Ayurvedic Standards Bodies]]
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 +[[Ayurvedic Pastoral Counselor]] ​ |  [[Ayurvedic Health Educator]]
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 +[[Ayurvedic Medical Ethics]] ​ |  [[Buddhist Ethics]] ​ |  [[Vedic Ethics]] ​ |  [[Ayurvedic Scams]]
 +----
 +
 +[[Ayurvedic Herbs]] ​ |  [[Top Ten Ayurvedic Herbs]] ​ |  [[Ayurvedic Material Medica]]
 +
 +[[Amalaki]] ​ |  [[Shilajit]] ​ |  [[Guggulu]] ​ |  [[Ashwagandha]] ​ |  [[Brahmi]] ​ |  [[Musta]]
 +
 +[[Organic Ayurveda]] ​ |  [[Ayurvedic Herb Suppliers]]
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 +[[Herbal Actions and Interactions]] ​ |  [[Language of Herbs]] ​ |  [[Ayurvedic Sanskrit]]
 +
 +[[Herbal Traditions]]: ​ [[Traditional Chinese Medicine]]
 +
 +[[Tibetan Medicine]] ​ |  [[Ayurvedic Medicine]] ​ |  [[Western Herbs]]
 +----
 +
 +[[Ayurvedic Glossary]] ​ |  [[Dharma Glossary]]
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 +[[Ayurvedic Encyclopedia]] ​ |  [[Ayurvedic Herbal Database]]
 +----
 +
 +[[Ayurvedic Nutrition]] ​ |  [[Ayurvedic Diets]] ​ |  [[Ayurvedic Food Lists]] ​ |  ​
 +
 +[[Ayurvedic Cookbook]] ​ |  [[Ayurvedic Recipes]] ​ |  [[Ayurvedic Cooking]]
 +
 +[[Ayurvedic Spices]] ​ |  [[Turmeric]]
 +
 +[[Ayurvedic Vegetarian]] ​ |  [[Ayurvedic Vegan]]
 +
 +[[Ayurvedic Food Therapy compared to Chinese]] ​ |  [[Energies of Foods]]
 +
 +[[Environmental Toxins]] ​ |  [[Toxins and Ayurveda]] - [[Ama]]
 +
 +[[Ayurvedic Digestion]] - [[Agni]]
 +
 +[[Constipation and Ayurveda]] - [[Triphala]]
 +
 +[[Irritable Bowel Syndrome and Ayurveda]] [[IBS]] - [[Avipattikar]]
 +
 +[[Food Supplements]] ​ |  [[Food Additives]] ​ |  ​
 +
 +[[Ayurveda and Vitamins]] ​ |  [[Nutraceuticals]]
 +
 +[[Obesity and Ayurveda]] ​ |  [[Anorexia and Ayurveda]]
 +
 +[[Immunity and Ayurveda]] ​ |  [[Immune Deficiency and Ayurveda]]
 +----
 +
 +[[Exercise and Ayurveda]] ​ |  [[Muscle and Ayurveda]] ​ |  [[Fat and Ayurveda]]
 +
 +[[Ayurvedic Yoga Therapy]]
 +
 +----
 +[[Sex and Ayurveda]] ​ |  [[AIDS and Ayurveda]] ​ |  [[STDs and Ayurveda]]
 +
 +[[Erectile Dysfunction and Ayurveda]] ​ |  [[Low Libido and Ayurveda]]
 +
 +----
 +
 +[[Ayurvedic Psychology]] ​ |  [[Sattva Rasas Tamas]]
 +
 +[[Ayurvedic Meditation Guidelines]] ​ |  [[Vipassana and Ayurveda]]
 +
 +[[Anxiety and Ayurveda]] ​ |  [[Anger and Ayurveda]] ​ |  [[Depression and Ayurveda]]
 +
 +[[ADD and Ayurveda]] ​ |  [[Manic-Depression and Ayurveda]] ​ |  [[Overeating and Ayurveda]]
 +
 +[[Technology and Ayurveda]]
 +
 +[[Ayurvedic Mantras]] ​ |  [[Ayurvedic Yoga]]
 +
 +[[Ayurvedic Spirituality]] ​ |  [[Nagarjuna Bodhisattva]] ​ |  [[Medicine Buddha]]
 +
 +[[Medicine King Bodhisattva]] ​ |  [[Ksitigarbha Bodhisattva]] - [[Great Vows]]
 +
 +[[Avalokiteshvara Bodhisattva]] -- [[Great Compassion]] ​ |  [[Tara]] ​ |  [[Great Compassion Mantra]]
 +
 +[[Manjushri Bodhisattva]] - [[Great Wisdom]] ​ |  [[Samantabhadra Bodhisattva]] - [[Great Practice]]
 +
 +[[Maitreya Bodhisattva]] - [[Great Patience]] ​ |  [[Vajrapani Bodhisattva]] - [[Great Protection]]
 +
 +[[Cause and Effect in Ayurveda]] ​ |  [[Dependent Origination]] ​ |  [[Ten Perfections]]
 +
 +[[Five Precepts]] ​ |  [[Bodhisattva Precepts]] - [[Benefit Others More than Your Self]]
 +
 +[[Ayurveda and the Bodhisattva Way]]
 +----
 +
 +[[Ayurvedic Treatments]] ​ |  [[Ayurvedic Diseases]] ​ |  [[Ayurvedic Pathology]]
 +
 +[[Ayurvedic Home Remedies]] ​ |  [[Chinese Medicine Home Remedies]]
 +
 +[[Heart Disease and Ayurveda]] ​ |  [[Cancer and Ayurveda]] ​ |  [[Stroke and Ayurveda]]
 +
 +[[Asthma and Ayurveda]] ​ |  [[Diabetes and Ayurveda]] ​ |  [[Alzheimers and Ayurveda]]
 +
 +[[Arthritis and Ayurveda]] ​ |  [[Chronic Fatigue and Ayurveda]]
 +
 +[[Insomnia and Ayurveda]] ​ |  [[Stress and Ayurveda]]
 +----
 +
 +[[Pancha Karma]] ​ |  [[Ayurvedic Detox]] ​ |  [[Nasya Therapy]] ​ |  [[Donating Blood]]
 +
 +[[Ayurvedic Enemas]] ​ |  [[Dashamula Tea]]  |  [[Sesame Oil]]
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 +
 +[[Ayurvedic Chromotherapy]] -- [[Color Therapy and Ayurveda]]
 +----
 +
 +[[Ayurvedic Womans Health]]
 +
 +[[Irregular Menstruation and Ayurveda]] ​ |  [[Painful Menstruation and Ayurveda]]
 +
 +[[Yeast Infections and Ayurveda]] ​ |  [[Menopause and Ayurveda]]
 +
 +[[Pregnancy and Ayurveda]] ​ |  [[Ayurvedic OBGYN]] ​ |  ​
 +
 +[[Ayurvedic Gynecology]] ​ |  [[Children and Ayurveda]]
 +----
 +
 +[[Ayurvedic Diagnosis]] ​ |  [[Ayurvedic Pulse Diagnosis]]
 +
 +[[Ayurvedic Tongue Diagnosis]] ​ |  [[Ayurvedic Nail Diagnosis]] ​ |  [[Ayurvedic Medical History Forms]]
 +
 +----
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 +
 +
 +----
 +[[Medicine Buddha Mantra]]: [[Om]] [[Namo]] [[Bhagavate]] [[Bhaisajya]] [[Guru]] [[Vaidurya]] [[Prabaha]] [[Rajaya]] [[Tathagataya]] [[Arhate]] [[Samyamsambodhi]] [[Tadyata]] [[Om]] [[Bhaisajye]] Bhaisajye [[Bhaisajya]] [[Samudgate]] [[Svaha]]!
 +
 +[[Medicine King Bodhisattva]] [[Jeweled Ax Mantra]] 16 (Line 64 of the [[Great Compassion Mantra]] of [[Avalokiteshvara]]):​ [[Syi lu seng e mu chywe ye Nan Wei la ye Wei la ye Sa wa he]].
  
ankylosing_spondylitis.txt · Last modified: 2018/03/14 08:02 (external edit)