Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group enthesitis

Hi everyone.

I was wondering what people do to control enthesitis with AS? The area around the metatarsals are incredibly angry because of a mechanical injury. I have rested and rested and rested and have given my foot more support with an orthotic (have prescription ones coming in the next two weeks, but finally found one to form to my high arch in the meantime), but they are absolutely on fire. I have a topical prescription for ketoprofen, which sometimes helps for a bit, but then they go right back on fire.


Any suggestions?
Thanks so much.

I also suffer from enthesitis and as like you I have A.S. I find that whatever medication I take for the A.S. also sorts out the enthesitis. So I take NSAIDs. and ordinary painkillers but am also on Enbrel. The NSAIDs I am on at present are Indometacin and they work as well as anything I suppose. Inflammation is inflammation whether it is in the joint or the ligament.

Hi Light,

Enthesitis, or inflammation of attachment sites, essentially puts a 'hole' in the periosteum (the membrane covering bone) at the relevant site and as a consequence chronic inflammation sets up there.
The muscle concerned shortens as a protective mechanism, which exacerbates the enthesistis and may lead to a new enthesitis at the other end of the muscle.
I've found cold packs applied to the site of the inflammation and to the muscle concerned can help greatly. Also, deep tissue massage aiming to lengthen the concerned muscle can relieve the pressure, or pulling effect, at the attachment site, and this is also beneficial.
One suggestion I've heard of, though not personally tried, is to freeze some mater in a polystyrene cup, or maybe a plastic drink bottle, then by rolling this over the muscle you can get a combination of cold and massage.
The muscles that attach to ligaments on top of the foot would be the extensor digitorum longus and the tibialis anterior - working lengthways along them.
Once established, the nature of the inflammation at such points of enthesitis is different to the gut based inflammation, and this, at least to me, explains why diet is a great preventative, but is less successful in knocking down the chronic inflammation at the extra-spinal attachments.

The abstract listed below, although conducted in a mouse model, indicates that blocking gut inflammation fails to reduce joint inflammation in established disease.


http://ard.bmj.com/content/76/Suppl_2/118.1

Personally, I've found that a powerful cortisone (e.g., Kenacort) when applied to an inflamed knee, for instance, can resolve long standing but distant enthesopathies in just a few days, and the result can be a permanent fix.

Regards David

Hi David,


Is this applicable to hip joint. In such cases diet will not be helpful?. From the article it appears that anti IL 17 will not be effective?. ( I don not know whether I understood correctly)

Jay

Hi Jay,

I'm still a great advocate for the LSD / NSD.

If you've got hip pain, then that's bad enough, but you don't want knee pain / synovitis as well; so adopting a No Starch Diet might prevent you developing further hot spots, and hopefully the hip pain would resolve, perhaps slowly, over the period of a few months.

I've had hip pain myself. In that case the muscle involved would probably be the gluteus maximus (buttocks). The muscle arises in part from the lower part of the sacrum and the side of the coccyx (this is close to the sacro-illiac joint) and inserts (at least in part along the lateral aspect of the femur. Bursa that lie deep to the muscle and near to the hip, if they later become inflamed (bursitis), can cause very irritating hip pain, that might persist for months or even years. Note, enthesitis always precedes bursitis and synovitis, that is, enthesitis when it first arises at a given point of attachment, does so in the complete absence of synovitis or bursitis.

Again cold packs and deep tissue massage might be helpful, at least can't hurt. Cortisone injections might also work, the difficulty being that targeting the bursa concerned might require some sort of CT or X-ray imaging.

Regards David

Hi Jay,

Yes, that's how I read it. Using a humanised anti-IL17 or Anti-IL23 (so called 'biologics') might not address existing points of inflammation. Perhaps a type of biologic might be added that could successfully knock down the inflammation associated with enthesitis / synovitis / bursitis.

Hi David,

Thank you for your elaboration. But I am yet to get the insight. I will try to understand probably with a sketch of hip region and come back.

I have developed antibodies to anti TNF. Hence, I was enquiring with my rheumy about Cosentyx, anti IL 17. He has mentioned that it is not much effective for AS. I have mainly SI inflammation. I am trying to corelate your post with doctor's comment.



What does this imply. Whether diet is not effective for SI inflammation. Improvement eluding me even with strict NSD for 10 months.

Regards.

Jay

Hi, Jay:

Regret strict NSD is not helping; this should obviate the need for any drugs.

I can say, especially in retrospect, that I would take antibiotics over biologics any day.

Have You gone on NSD and Diet Forum to troubleshoot diet? From past experiences, I can only speculate about something off with the diet OR some severe heavy metal issue.

Have You done the EVOO and borage seed oils?

HEALTH,
John

Hi John,

Thank you.

I have done borage seed oil as you have suggested, 6 capsules a day, for a week and wheat grass juice in empty stomach. With the left out capsules, presently I am taking 2 capsules a day. I am taking EVOO 5 – 6 tsp every day for the past 6 months. My stool is normal and do not have stomach issues.

I have taken oregano oil 3 drops (tiny) a day twice for 3 days. Since, I felt exhaustion similar to antibiotic treatment, dry throat and hence I stopped it. I could not manage even 3 days. Hence, I am bit apprehensive to try long antibiotic treatment. I started taking probiotics.



I am taking very strict NSD with much criticism from my family, since it is not showing any improvement. I have been regularly checking once in two months for heavy metals also for the last 10 months. The metals Arsenic, Cadmium, Mercury, Lead, Chromium, Barium, Cobalt, Caesium and Selenium have been within normal limits. My iron level was a bit higher 7 months back and has become slowly normal two months back, by restricting iron rich foods.



I am checking up here at Kickas regularly. My son also checks up at FB for LSD/NSD for AS and AS India. You mean any other diet forum?.

Do you have any further advice.

Regards.

Jay

Hi John,

Sent an email as suggested by you. Kindly check up.

Regards.

Jay