A patient with ankylosing spondylitis (AS) showed clinical improvement in symptoms with alternative and complementary therapies after withdrawal of adalimumab, according to data from a case report published in Complementary Therapies in Clinical Practice.

The report described the case of a 38-year-old woman with a history of uterine leiomyoma who was diagnosed with AS in April 2017. The patient tested human leukocyte antigen (HLA) B27-positive and presented with symmetrical and bilateral sacroiliitis on imaging. She was initiated on adalimumab treatment in August 2017, which showed improvements in inflammatory biomarker levels. However, after 9 months of treatment, the patient experienced disseminated and refractory Molluscum contagiosum infection. These infections precluded further use of adalimumab; treatment was discontinued in September 2018.

The patient was then initiated on a 60-day course of supplements, each taken twice daily: Astragalus membranaceus (150 mg), Vaccinium macrocarpon (250 mg), Optuntia indica ficus (50 mg), dismutase superoxide (100 mg), and caviar phospholipids (75 mg). Within 1 month, the patient experienced resolution in disseminated skin lesions, though still remained symptomatic for AS.


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An “integrative medical approach [of] supplement use…[with] an anti-inflammatory diet ” was discussed with the patient. According to this approach, the patient received a single intramuscular injection of vitamin D3 600,000 IU and a single dose of albendazole 400 mg that was repeated after 15 days. The patient received a series of supplements once daily — Curcuma longa (500 mg), Rhodiola rosea (400 mg), and omega-3 (3g)— and self-administered a formula containing selenium (100 μg), methylcobalamin (800 μg), pyridoxine (100 mg), zinc (40 mg), vitamin C (500 mg), and coenzyme Q10 (100 mg). The patient was also instructed to adhere to an anti-inflammatory diet, which eliminated dairy, gluten, and sugar.

With the help of this regimen, the patient experienced progressive clinical improvement in AS symptoms. After 2 months, erythrocyte sedimentation rate (ESR) was found to be reduced substantially compared with pre-treatment levels (23 mm vs 29 mm in the first hour). The C-reactive protein (<0.3 mg/L vs 1.57 mg/L) and alpha-1-acid glycoprotein (46 mg/dL vs 139 mg/dL) levels were also substantially reduced at 2 months on treatment compared with pre-treatment levels. A reduction in anti-thyroid peroxidase antibodies (42.2 U/mL to 15.6 U/mL) was also observed.

Imaging showed significant physical improvements in the sacroiliac joint. Vitamin D, calcium, zinc, and vitamin B12 levels remained at normal levels during treatment, with none of them reaching toxicity. Although the patient reported intermittent episodes of back pain during treatment, inflammatory biomarkers remained at normal levels. A further clinical response was observed when treatment was supplemented with regular physical exercise and twice-daily administration of cyclobenzaprine 5 mg and 5-hydroxytryptamine 50 mg.

“This report describes an efficacious alternative and complementary approach to treating uncommon inflammatory conditions such as AS,” wrote author Dr Jozélio Freire De Carvalho. “Dietary changes and supplementation were effective in alleviating disease-related inflammatory processes, he noted.”

Reference

Freire de Carvalho J. Successful treatment of ankylosing spondylitis with alternative and complementary medicine withdrawal of adalimumab treatment. Complement Ther Clin Pract. Published online October 24, 2021. doi:10.1016/j.ctcp.2021.101494