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This is a spa resort in Austria with very unusual environmental conditions. A
trip within the mountains of the valley will be through an environment
which includes :
- radon
gas which is naturally radioactive (though this is a very mild form
of radioactivity and there are no higher rates of cancer among local
people than in other areas of Austria)
- an air
temperature of 37.5°C-41.5°C and
- humidity
of 70%-90%.
This
means, sauna like conditions in a mildly radioactive environment.
Research
on 120 Dutch people with AS showed that people who attending the Spa
in Austria showed improved function, well-being, and less morning stiffness
when compared to people who stayed at home and continued on their normal
treatment. This improvement lasted for 40 weeks while the improvement
seen in people who went to a normal spa (and had all the exercise and
hydrotherapy ) lasted 16 weeks. Therefore this study suggests a long
term benefit from visiting the Austrian Gasteiner Heilstollen spa. If
you would like any more information the web address for the spa is :
http://gasteiner-heilstollen.info/dt/d1/
A person
needs to be referred by a doctor and to have a health check up when
at the resort.
References:
van Tubergen
A, Landewe R, van der Heijde D, Hidding A, Wolter N, Asscher M, Falkenbach
A, Genth E, The HG, van der Linden S. Combined spa-exercise therapy
is effective in patients with ankylosing spondylitis: a randomized controlled
trial. Arthritis Rheum 2001 ;45 (5): 430-8.
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Acupuncture:
 Acupuncture
has been used along side conventional medicine to relieve symptoms of
arthritis . Acupuncture is a traditional Chinese medicine where thin
needles are inserted in specific documented points believed to represent
a position of concentration of body energies. In some cases a small
electrical impulse is added to the needles (electroacupuncture). Once
the needles are inserted in some of the appropriate points, endorphins,
morphine-like substances, have been shown to be released in the patient's
system, thus inducing local or generalized analgesia.
Trials
have been carried out were people with arthritis (osteoarthritis and
rheumatoid arthritis) are randomly given acupuncture or nothing/sham
acupuncture . Results from these studies suggest that acupuncture may
help relieve pain (electroacupuncture more so) but does not improve
function. General recommendations from these trials are that acupuncture
can not be recommended as a treatment for arthritis as it was thought
that the relief was very short lived and some of the improvement seen
could be due to a large placebo effect. However, electroacupuncture
has been found to be effective when used on rats within a laboratory. The
rats showed a 40% recovery for a short period of time (similar to the
recovery seen when given an injection of pain killer). The improvement
was not seen when acupuncture was deliberately carried out the wrong
place on the foot.
Research
published in journals for traditional Chinese medicine suggest that
acupuncture with bee venom is more effective.
Thus, in
summary acupuncture may help reduce pain in the short term (ie over
24 hours) but does not cause changes to the disease or reduce the inflammation.
References
:
Ferramdez
Infante A, Garcia Olmos L, Gnzalez Gamarra A, Meis Meis MJ, Sanchez
Rodrigues BM. Effectiveness of acupuncture in the treatment of pain
from osteoarthritis of the knee. Aten Primaria 2002 30(10): 602-9.
Koo ST,
Park YI, Lim KS, Chung K, Chung JM. Acupuncture analgesia in a new rat
model of ankle sprain pain. Pain 2002; 99 (3): 423-31.
Casimiro
L, Brosseau L, Milne S, Robinson V, Wells G, Tugwell P. Acupuncture
and electroacupuncture for the treatment of RA.
Ezzo J,
Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, Berman B. Acupuncture
for osteoarthritis of the knee: a systematic review. Arthritis Rheum
2001; 44(4):819-25
Kang SS,
Pak SC, Choi SH. The effect of whole bee venom on arthritis. Am J Chin
Med 2002;30(1):73-80
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Glucosamine
sulfate:
 Glucosamine
is a naturally occurring derivative of glucose and is an essential part
of glycoproteins and proteoglycans, which help form many proteins.
Glucosamine is produced in cells. Commercially, glucosamine is
sold over-the-counter to relieve arthritis. Although there is evidence
in favor of the beneficial effects of glucosamine, the mechanism is
unknown. It is thought that glucosamine stops the signal which makes
some of the chemicals involved in inflammation. This means it could
have immunosuppressive effects (ie suppress parts some aspects of the
immune and inflammation system). However, people with insulin sensitivity
need to be aware that glucosamine comes from sugar.
Research on glucosamine and arthritis has mainly been in osteoarthritis
and not in ankylosing spondylitis. The findings of research have
suggested that glucosamine is effective and equivalent to ibuprofen.
In a 3 year study on osteoarthritis of the knee, fewer people taking
glucosamine sulfate had severe narrowing of the knee joining (ie worse
disease as seen on an X ray) symptoms and function improved with the
glucosamine group. So long term treatment with glucosamine slowed progression
of knee osteoarthritis.
Glucosame
has been found to be equivalent or superior to normal NSAID (ie anti-inflammatory
drugs) for the treatment of osteoarthritis. Therefore, it can be used
instead of or with normal anti-inflammatory drugs. However, an important
benefit in osteoarthritis is that it helps cartridge to repair (which
is important in knee osteoarthritis) but this is unlikely to be of benefit
in ankylosing spondylitis.
References
:
Pavelka
K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC.
Glucosamine sulfate use and delay of progression of knee osteoarthritis:
a 3-year, randomized, placebo-controlled, double-blind study. Arch
Intern Med 2002 Oct 14;162(18):2113-23
Ma L,
Rudert WA, Harnaha J, Wright M, Machen J, Lakomy R, Qian S, Lu L,
Robbins PD, Trucco M, Giannoukakis N.Immunosuppressive effects of
glucosamine.J Biol Chem 2002 Oct 18;277(42):39343-9
Ruane
R, Griffiths P. Glucosamine therapy compared to ibuprofen for joint
pain. Br J Community Nurs 2002 Mar;7(3):148-52
Noack W, Fischer M, Forster KK, Rovati LC, Setnikar I. Glucosamine
sulfate in osteoarthritis of the knee. Osteoarthritis Cartilage 1994
Mar;2(1):51-9
Towheed
TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC. Glucosamine
therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001;(1):CD002946
Reginster
JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, Giacovelli
G, Henrotin Y, Dacre JE, Gossett C. Long-term effects of glucosamine
sulphate on osteoarthritis progression: a randomised, placebo-controlled
clinical trial. Lancet 2001 Jan 27;357(9252):251-6
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Diet
and AS:
 1
in 4 people with ankylosing spondylitis have tried specific diets to
relieve arthritis symptoms. Half of the people (46%) reported that they
had less pain and stiffness when on special diets. Some people with
AS have tried fasting periods and 2 in 3 people undertaking fasting
reported less pain and stiffness. However, there are very few published
studies examining diet and reduction of arthritis symptoms.
The theory
: There is strong evidence that the trigger for Ankylosing Spondylitis
is bacteria in the gut. However, whether bacteria are involved in making
the arthritis worse once disease is already established, is not so clear.
It is thought that people with ankylosing spondylitis have a ‘leaky’
bowel that lets through bacteria and other things that could make arthritis
worse. It has been suggested that if you do not eat the food that the
bacteria like, you could get rid of most of them and they would then
not aggravate the arthritis. A study was published in 1996 that suggested
a low starch diet (ie not eating bread, potatoes, cakes and pasta) could
help alleviate the symptoms of AS. However, no further studies have
been published to confirm this finding.
It could
be argued that a temporary benefit will be felt if you change your diet
radically in any way (ie eat fish and not meat or stop eating meat and
only eat starch). Changing your diet means you change the bacteria in
the gut. However,  within
a short time it is likely that lots of new bacteria will have moved
into your gut and the symptoms of AS will return.
Dangerous
diets : Radical diets which remove essential vitamins and nutrition
should not be followed. It is possible that radical diets will work
in reducing the symptoms of AS since a person needs to be healthy to
mount an immune response. If you lack certain minerals and vitamins
you will not be able to defend the body from outside attack and will
also not be able to attack your own joints. Therefore, the arthritis
symptoms may improve but the chance of infection and illness due to
a poor immune system will also increase.
An alternative
: The use of ‘friendly’ bacteria (such as live yoghurts
eg Yacult and Actimel type products) are being tried for autoimmune
disease and could help perhaps in addition to eliminating food that
may aggravate the arthritis. However, research to date is limited and
whether live bacteria can help specific diseases is unclear.
In summary
: There is very little published work supporting the finding that diet
can help reduce the symptoms of arthritis. It is unlikely that the bacteria
which triggers AS are involved in making it worse. The things which
make a person develop AS do not appear to be the same things that make
the symptoms severe or mild. People in different countries like Alaska
where the diet is mainly protein and little starch, do not have mild
disease. Vegan diets have been reported to help AS, yet this is a diet
consisting mainly of starch.
However,
if a person feels benefit and has checked with their doctor that the
diet they are following is safe then there is no reason not to remain
on a reduced starch diet (much like the Atkins diet).
References
:
Haugen
M, Kjeldsen-Kragh J, Nordvag B Forre O. Diet and disease symptoms
in rheumatic diseases – results of a questionnaire based survey.
Clin Rheumatol 1991; 10(4): 401-7.
Vaile
J, Meddings J, Yacyshyn B, Russell A, Maksymowych W. Bowel permeability
and CD45RO expression on circulating CD20+ B cells in patients with
ankylosing spondylitis and their relative. J Rheumatol 1999; 26(1):
128-35.
Elbringer
A, Wilson C The use of a low starch diet in the treatment of patients
suffering from ankylosing spondylitis. Clin Rheumatol 1996; 15 (Supp
1): 62-66.
Kanauchi
O, Mitsuyama K, Araki Y, Andoh A. Modification of intestinal flora
in the treatment of inflammatory bowel disease. Curr Pharm Des. 2003;
9 (4): 333-46.
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