Lifestyle Changes with Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: July 2020

Axial spondyloarthritis (AxSpA) is a chronic, progressive condition. Treatments are available to help manage the condition but there is no cure. Because there is no cure, the goals of treatment are to maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1 Although lifestyle changes may not be the first thing that comes to mind when thinking about AxSpA spectrum treatments, they can be very helpful in managing symptoms, promoting wellness, and increasing quality of life.

Diet and AxSpA spectrum conditions

Maintaining a healthy diet is important for anyone, but especially so if you live with a chronic illness or condition. While diet cannot cure or change AxSpA, there are some things you can do to help minimize symptoms. If you don’t know where to begin or are planning on dramatically changing your diet, talk with your doctor about seeing a nutritionist. They’ll be able to help you put together a healthy diet plan and ensure you get all of the nutrients you need.

A healthy weight is important because the more you weigh, the more stress is placed on your joints. When you walk, the hips, knees, and ankles can bear 3 to 5 times your body weight.2 If you are overweight, talk with your doctor about healthy ways to lose weight in order to ease the stress on your joints.

There are some claims that certain diets have helped ease the symptoms related to inflammation in AxSpA spectrum conditions. These diets are typically related to bacteria in the gut, like the low starch diet.2 Further research found that there are not many studies on the relationship between diet and AxSpA spectrum conditions, and the studies that do exist have methodological weaknesses.3 While individuals may feel these diets have helped ease symptoms, this has not been clinically proven yet.3

A healthy diet should include fruits and vegetables to get a variety of antioxidants and enough fiber; protein through fish, beans, meat, nuts, and eggs; calcium for strong bones; and starch (preferably whole grains).2 Omega-3 fatty acids have been found to ease symptoms in some people with inflammatory arthritis; these can be found in oily fish like sardines, or almonds.2 There are also supplements you can take to get omega-3 fatty acids. Talk with your doctor about this, as it’s not for everyone.

Sleep Problems and AxSpA spectrum conditions

Nearly 66 percent of people living with AxSpA spectrum conditions report fatigue, and poor sleep quality contributes to this.4 Nearly half of people living with AxSpA spectrum conditions, or 46 percent, have moderate to severe insomnia.4 This may be related to pain or stiffness. The lack of sleep then contributes to the fatigue, which is then made worse by continued pain or stiffness the following day.

Some things to do to help promote better sleep include:4

  • Use a firm, flat mattress to encourage good sleeping posture
  • Sleep on your back to avoid bending the spine and hip joints
  • Do not use thick, big pillows that lift the shoulders and bend the spine
  • Do not put a pillow under your knees while sleeping

Smoking cessation

Smoking cigarettes is bad for your health in general, but is especially bad for AxSpA spectrum conditions. In people with early-stage AxSpA, cigarette smoking was associated with higher disease activity, more structural damage on radiographic tests, more inflammation, decreased functional ability, and lower quality of life.5

For those with AxSpA spectrum conditions who quit smoking, quitting was found to be associated with lower disease activity and better physical functioning and improved quality of life.6 The benefits of quitting smoking were found to be equal to about 30 percent of the effect a person might get from intensive physiotherapy and 16 percent of the effect of biologic therapy.6 Quitting smoking, then, can have a significant impact on both disease process and quality of life.

Quitting smoking can be very difficult. If you need assistance, talk with your doctor about smoking cessation techniques or medications. You don’t have to do this alone. It’s a big step, and support is available.

Other lifestyle changes for AxSpA spectrum conditions

Other lifestyle changes that you might want to consider include:4

  • Maintaining proper posture
  • Avoiding sitting for prolonged periods
  • Wearing shoes with shock-absorbing heels
  • Avoid physical activity that strains the neck or back
  • Get some form of physical exercise every day
  • Participate in physical therapy with a trained professional
  • Use a back cushion on your car seat
  • At work, get up frequently and walk around so you aren’t sitting for prolonged periods of time
  • Consider installing a shower bar or bench for the shower, for support
  • Avoid loose carpet and slippery surfaces

Talk with your doctor about the current symptoms you’re experiencing and if they have any recommendations for lifestyle changes. Some people may not need to adjust their lifestyle very much, while others may need to adjust a little more. You may find that lifestyle changes can vary as your condition progresses or depending on your symptoms at any given time.

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