T Nation

Ankylosing Spondylitus


So this maybe a tricky one but there are several of you i am hoping will offer me some guidance.

A kid (well 25) i sometimes train with back home told me he is awaiting confirmation from the hospital that he has Ankylosing Spondylitus (AS)

Now the reason i got trainin with this kid was that i have had piriforis syndrome and been unable to squat, deadlift or do any hip intensive work, we assumed he had the same and while the physio i did worked, his didnt.

An MRI scan revealed severe inflammation of the sacroiliac joint on both sides, a small bone spike and interestingly some loops in the bowel - in y opinion this could point towards Crohns or ulcerative collitus but when he brought this up with his doctor they were dismissive of it.

Anyway, to get back on track, the guy was weighing in at around 230lb when i met him with several solid cycles under his belt and was considering giving growth hormone a run when i begin.

Now with the condition he has been in, his training has been severely impaired, dietary changes have had to be made. Low Carb, and i mean continuosly below 30g a day for nearly 6 months now (it keeps the inflammation therefore the pain down for him) So he finds himself at 198lbs as of last week and rather depressed, one may actually deem him almost suicidal.

For those of you who do not know much of the disease, it has the potential to leave one crippled in later life, in pain and unable to perform alot of everyday tasks, training included.

Until he tells me the actual diagnosis nothing can be certain, but one thing he mentioned alot was his uncertainty towards future steroid/peptide use.

As of 7 months ago he has used no steroids at all, basically because he cannot bare the extra water and the worsening of inflammtion, and because he cannot train or eat as much as he needs to there really hasnt been much point.
Now this guy lives for bodybuilding so i am hoping someone can tell me that yes, steroids and growth hormone could be something he will be able to enjoy again if AS is confirmed as the condition he has.

My knowledge and research offers a mixed opinion but then again as you all know, i aint that bright lol



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Cheers for that mate. Appreciate it.

As far as bad foods go, the only ones which cause him discomfort are starches, and the discomfort is in the SIJs, no discomfort in the digestive system.
Previously as well there has been no digestive problems, no diahorrear (spelling*) or any other unusual occurences.

The anabolic diet is what he has followed religiously minus carb up days which he struggles to tolerate.

Tests have comeback negative for rheumatoid factors it is worth mentioning.

Again, thanks mate for taking the time to respond, i will forward the above posts to him and suggest the ice belt.


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again thanks for the info mate, what i mean is that he hasnt suffered any direct symptoms to the uneducated mind which would point to an intestinal problem; obviously i am open to hearing anything which may point away from AS etc, like i said the poor kid is almost suicidal.

Thanks again mate


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But first, a diagnosis. Or two. Can one diagnosis explain sacroilliitis, weight loss and symptoms aggravated by "carbohydrates?"

"[i]1: Dig Dis Sci. 1995 Sep;40(9):1906-8.
Adult celiac disease is frequently associated with sacroiliitis.

Usai P, Boi MF, Piga M, Cacace E, Lai MA, Beccaris A, Piras E, La Nasa G, Mulargia M, Balestrieri A.
Istituto di Medicina Interna, University of Cagliari, Italy.
No data are available on the presence and frequency of peripheral or central joint disease, routinely determined by bone scintigraphy with 740 MBq of [99mTc]MDP, in adult celiac disease.

Bone scintigraphy was carried out to detect early acute inflammatory lesions in 22 adult celiac patients (15 females and seven males; mean age 36.72 years, range 17-63). Bone scintigraphy was positive for sacroiliitis in 14 cases (63.6%).

Except in the case of one patient suffering from rheumatoid arthritis, laboratory data were normal. Our data suggest that as in other chronic intestinal diseases, celiac disease in adults, is frequently associated with central joint disease.

This high incidence of sacroiliitis, the joint disease most frequently found in our patients, has not been previously reported in other series. We believe, therefore, this difference could be explained by the different methodology used for the screening of joint disease."[/i]

This might be specious; there are few follow-up citations in confirmation. In any case, carbohydrates do not typically aggravate inflammatory bowel disease (UC and Crohn); but gluten most assuredly aggravates gut and extraintestinal symptoms of celiac disease.

The algorithm for your friend is straightforward: antimysial and antiTGT antibodies, endoscopy to distinguish among celiac, Crohn and UC, or whatever technique is used in Britain.

Withdraw gluten, if appropriate, or treat for UC/Crohns, but blindly adding anabolics will not work until the gut inflammation is addressed specifically (and no, fish oil does not work).

And it is possible to have more than one thing: e.g., UC and AS; or UC and celiac disease can co-exist. This is why they pay spine radiologists; the classic findings of AS occur late. (B27 testing is not good enough for the question posed.)

Best of luck...


I'm 27rys old and have had AS for about 7 years now. All joints are effected. Even you nose , chest expansion and knuckles..

The main problem though is the lose of flexibility of your Sacroilliac joint.
WHich i find there isn't much you can do about it except swimming and hydrotherapy.

I also play cricket for my club as a fast bowler and find it vital in keeping healthy as it keeps all your joints moving and prevents them from fusing or stiffening up.

One of the main things is to never stay still for too long. Lying on beds for a day resting even makes it worse.

There are drugs out there such as Humira , Remicade and others which are injections of a certain TNF blocker which stops the disease from progessing. Humira has me pain free and able to do whateva i need within reason. No contact sports or heavy drinking for me. But i can train which is the main thing.

Watch out for rotator cuff injuries with AS. Your shoulder seems to crack no matter how much training goes into fixing your shoulder girdle.. DUnno what to do about that. Maybe an inpingement there.



I have also noticed a big improvement in hip strength and flexibility after starting kettlebell swings. They seem to unhinge your stiffness in the spine if you haven't been fused together to far already.

Good spinal erectors and romboids go a long way to keeping your back pain free. do your hypers and deadlifts if you can.