Are Dietary Supplements Safe for Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is a type of arthritis characterized by chronic inflammation of the joints and ligaments of the spine. Over time, the inflammation causes stiffness and back pain.

Because there is no cure for AS, treatment typically focuses on medications and therapies to reduce pain and prevent the condition from worsening. In some cases, certain dietary supplements may also be beneficial.

This article will discuss supplements for ankylosing spondylitis, including which ones have proven benefits and those that need additional research.

Understanding Ankylosing Spondylitis

Ankylosing spondylitis is a form of arthritis that causes lower back pain and joint stiffness due to inflammation. Symptoms are usually more severe following periods of rest or inactivity.

As the disease progresses, it can ultimately cause the spinal bones to grow together, leading to a total fusion of the spine. This can result in a limited range of motion and make everyday tasks difficult.

Although the exact cause remains unknown, researchers believe AS is caused by genetic and environmental factors. AS affects young men more than women and often develops between ages 17 and 35.

While there is no cure for AS, seeking early treatment may prevent long-term complications from developing.

Supplements That May Help

Many people with AS seek alternative treatment methods, including herbs, vitamins, minerals, and other dietary supplements.

Omega-3 Fatty Acids

Omega-3 fatty acids may help reduce inflammation. Several studies have proven their effectiveness in reducing inflammation in people with rheumatoid arthritis, which is closely related to AS.

Although studies on omega-3 fatty acids and AS are limited, one study found that higher doses of omega-3 supplements (about 4.5 grams per day) significantly reduced disease activity. However, larger, more controlled studies are needed before conclusions can be made.

Vitamin D

Vitamin D is essential for strong bones and muscles. Without it, your body cannot properly absorb calcium, which is also important for bone health.

According to a review, higher vitamin D levels are linked to a decreased risk of AS. Researchers also found a link between higher vitamin D levels and reduced disease activity. Another study reported that AS patients tend to have lower levels of vitamin D. Researchers suggest that vitamin D levels should be considered when forming a treatment plan.

Although the exact cause remains unknown, some studies suggest that people who take oral steroids are twice as likely as the general population to be deficient in vitamin D. Oral steroids are often prescribed to AS patients to treat short-term flare-ups.

Curcumin

Curcumin is the most widely studied component of turmeric. It is widely used to treat pain and inflammation associated with several diseases.

According to one review, curcumin may improve morning stiffness, joint swelling, and walking time in patients with rheumatoid arthritis.

Turmeric extract composed of curcumin may help block inflammation pathways and prevent the action of a protein that causes swelling and inflammation.

Calcium

Calcium is involved in many important processes, such as regulating inflammation, bone formation, and bone loss, all of which can occur in patients with AS.

A study suggests calcium supplementation should be mandatory in AS patients who:

• Have osteoporosis (disease that leads to weak and brittle bones)
• Have osteopenia (disease causing loss of bone density)
• Smoke cigarettes
• Have other known risk factors of bone demineralization such as intestinal malabsorption and comorbidities that require long-term use of corticosteroids 

Keep in mind, excess calcium supplementation can lead to constipation, kidney stones, and possibly an increased risk of heart disease in women.

Folic Acid

Methotrexate, such as the brand Trexall, a chemotherapy drug developed to treat cancer, is often prescribed in smaller doses to treat spondylitis symptoms. Taking folic acid supplements with methotrexate can reduce side effects such as nausea and oral ulcers and improve medication compliance.

Supplements That Need More Research

Although some supplements may treat other health conditions, we need more research to confirm their effectiveness in treating symptoms of AS.

Devil’s Claw

Devil's claw is an African herb used for years to treat pain and fight inflammation. Although several studies suggest that devil's claw can reduce pain and improve physical functioning in people with osteoarthritis, there is no solid evidence to support its use in those with AS.

Glucosamine

Glucosamine is a natural substance found in the body. It plays a vital role in building cartilage. There is evidence that glucosamine supplements can reduce pain in people with knee osteoarthritis. However, it is not recommended by the American College of Rheumatology for the treatment of osteoarthritis.

Unlike osteoarthritis, a degenerative joint disease, AS is a chronic inflammatory autoimmune disease.

More studies on glucosamine supplements in people with AS are needed to determine if participants have similar effects.

Chondroitin

Chondroitin is a chemical found in the cartilage of humans and animals. It is often used in combination with glucosamine to treat symptoms of osteoarthritis. The American College of Rheumatology does not recommend chondroitin for the treatment of osteoarthritis.

Similar to glucosamine, chondroitin has shown to be effective at providing pain relief to those who suffer from osteoarthritis. However, there isn't substantial evidence to suggest it has those same benefits in those who have AS.

How to Choose the Right Supplement

Although some supplements have evidence to support their use, more and larger controlled trials are necessary before any supplements can be routinely recommended in AS patients.

It's important to remember that the Food and Drug Administration (FDA) does not review supplements for safety and effectiveness before they go to market.

Before starting any supplement to treat AS, it's important to discuss the supplement with your healthcare provider. If they agree, you'll want to choose your supplement from a reputable brand that utilizes third-party testing to ensure it meets specific criteria and standards.

Tips to Prevent AS Flare-Ups

Making lifestyle changes can help you manage your condition. Tips to prevent AS flare-ups include:

• Take your medications as prescribed.
• Prioritize exercise.
• Avoid excess alcohol consumption.
• Participate in physical therapy.
• Eat a well-balanced, antioxidant-rich diet.
  
• Maintain a healthy weight.
• Utilize stress reduction techniques.

Summary

Ankylosing spondylitis is a form of arthritis that causes chronic inflammation of the spine and joints. Although there is no cure, it can be managed by making lifestyle changes and sticking to your treatment plan. The research on dietary supplements for AS remains mixed. While some supplements such as calcium, vitamin D, omega-3 fatty acids, curcumin, and folic acid have evidence to support their use, others do not.

A Word From Verywell

If you are looking for a way to manage ankylosing spondylitis, you may consider using supplements alone or in conjunction with traditional drug therapies. Either way, it is important to speak with your healthcare provider before taking supplements. It's also important to remember the research remains mixed on the effectiveness of supplements for AS. Working closely with your healthcare team can help you optimize your health and prevent or delay disease progression.