Biopsychosocial Management of Rural Ankylosing Spondylitis in a Pregnant Woman: A Case Report

Abstract

In a rural Japanese setting, this case report delves into managing a post-partum woman diagnosed with ankylosing spondyloarthritis (AS), showcasing the complexities of balancing effective pain relief with breastfeeding. The study highlights a multifaceted approach that incorporates medical treatment, psychosocial support, and comprehensive patient education, which are essential in rural healthcare where resources may be scarce. Initially managed with diclofenac due to its safer profile for breastfeeding, the patient's treatment was eventually escalated to adalimumab, aligning with improved circumstances regarding breastfeeding. This case emphasizes the critical role of holistic, patient-centered care in family medicine, particularly for managing maternal and child health chronic conditions. It illustrates how integrating mental health support, acknowledging patient fears, and educating families can significantly enhance patient care and outcomes. Through this approach, the report advocates for a broader application of family medicine principles to improve maternal and child health services in rural settings, demonstrating the importance of tailored healthcare strategies that consider patients' medical and emotional needs.

Keywords: ankylosing spondylitis; breastfeeding; maternal health services; pain management; patient-centered care; rural health services.

Figure 1. X-ray of the back (A) and pelvis (B) showing multiple bone spurs in the thoracic and lumbar vertebrae and the bilateral deformation of sacroiliac joints (white arrows)

Figure 2. Magnetic resonance imaging of the thoracic and lumbar vertebra (A) and pelvis (B) confirming the inflammation of the vertebral and sacroiliac joints (white arrows)