What is Ankylosing Spondylitis?
Ankylosing Spondylitis (AS) — now classified under the broader umbrella of Axial Spondyloarthritis (axSpA) — is a chronic, progressive inflammatory arthritis that primarily targets the sacroiliac joints and spine. "Ankylosis" means fusion and "spondylitis" means inflammation of the spine. In its most severe form, AS causes the vertebrae to fuse together, creating a rigid "bamboo spine," causing significant pain, disability, and loss of quality of life.
AS is part of a family of diseases called Spondyloarthropathies (SpA), which also includes Psoriatic Arthritis, Reactive Arthritis, and Enteropathic Arthritis (associated with Inflammatory Bowel Disease). The presence of the genetic marker HLA-B27 is a defining feature of this disease family.
MRI showing active sacroiliitis — the earliest and most characteristic finding of Ankylosing Spondylitis.
Symptoms: The Cardinal Features
The most characteristic symptom of AS is inflammatory back pain — a distinct type of back pain that physicians are trained to recognize. Unlike the much more common mechanical back pain, inflammatory back pain has specific features:
- Insidious onset before age 40, often starting in the late teens or twenties.
- Improves with exercise and activity, but worsens with rest — completely opposite to mechanical back pain.
- Night pain that wakes the patient from sleep, especially in the second half of the night.
- Morning stiffness lasting more than 30-45 minutes.
- Alternating buttock pain — indicating sacroiliac joint involvement.
- Enthesitis: Painful inflammation at sites where tendons and ligaments attach to bone, classically at the heel (Achilles tendon insertion and plantar fascia).
- Peripheral arthritis: Large joint involvement (hips, knees, shoulders) in some patients.
- Uveitis: Sudden onset of a painful, red eye — occurs in up to 40% of AS patients and requires urgent ophthalmological attention.
📊 Diagnostic Delay in AS
The average diagnostic delay for Ankylosing Spondylitis is 7-10 years in India. This is because the condition is often mistaken for common mechanical back pain. By the time a diagnosis is made, significant spinal damage may have already occurred. If you have chronic back pain starting before age 40 that improves with exercise, please see a Rheumatologist immediately.
X-ray of advanced AS showing syndesmophytes (bony bridges) between vertebrae — the classic "bamboo spine."
Diagnosis: Finding AS Before Damage Occurs
The diagnosis of AS involves a meticulous combination of clinical assessment, laboratory investigations, and imaging:
- HLA-B27 gene test: Positive in 90-95% of AS patients. A highly useful marker, but not diagnostic on its own (5-8% of the healthy Indian population also carry HLA-B27).
- MRI of Sacroiliac Joints: The most sensitive imaging tool for early AS (non-radiographic axial SpA). MRI can detect bone marrow edema — the signature of active sacroiliitis — years before any damage is visible on X-rays. This allows treatment to begin in the "window of opportunity."
- X-ray of the pelvis and spine: Used to detect structural damage (erosions, sclerosis, syndesmophytes, fusion) in established disease.
- Inflammatory markers (ESR, CRP): Elevated in active disease; useful for monitoring treatment response.
- ASDAS (Ankylosing Spondylitis Disease Activity Score): A validated composite score used to measure disease activity and guide treatment decisions.
Treatment: Preserving Your Spine
The goals of AS treatment are to reduce pain and stiffness, prevent structural damage (spinal fusion), and maintain physical function and quality of life. Treatment involves a combination of pharmacological and non-pharmacological approaches:
Non-Pharmacological (Essential, Not Optional)
Regular, structured physiotherapy and exercise are the backbone of AS management. Spinal extension exercises, swimming, and yoga maintain spinal flexibility and posture. Stopping smoking is also critically important, as smoking accelerates spinal damage in AS.
NSAIDs (First-Line)
Non-steroidal anti-inflammatory drugs (NSAIDs) like Diclofenac, Etoricoxib, and Naproxen are the first-line pharmacological treatment. In AS, continuous NSAID use (as opposed to on-demand use) has been shown to slow structural progression.
Biologics: TNF Inhibitors & IL-17 Inhibitors
When NSAIDs fail to provide adequate control, biologic therapies are transformative. TNF inhibitors (Adalimumab, Etanercept, Infliximab, Certolizumab) were the first biologics approved for AS and dramatically reduce pain, improve function, and may slow structural damage. IL-17 inhibitors (Secukinumab, Ixekizumab) are equally effective and are particularly beneficial for patients with concomitant psoriasis.
Dr. Prateek's Approach to Ankylosing Spondylitis
The tragedy of AS is not the disease itself — it's the years of diagnostic delay during which preventable spinal damage accumulates. Dr. Prateek Deo's mission is to end this delay. He actively screens all young patients presenting with chronic back pain for inflammatory features, using MRI sacroiliac joints to detect the disease at its earliest, most treatable stage.
Early Detection Focus
We use MRI to diagnose "non-radiographic axial SpA" before any bone damage has occurred — treating the disease in its window of opportunity.
Personalised Exercise Plans
We collaborate with physiotherapists to create structured, supervised exercise programmes tailored to your disease severity and physical capacity.
Biologic Expertise
We have extensive experience in prescribing and monitoring biologic therapies (TNF & IL-17 inhibitors), ensuring optimal dosing and vigilance for side effects.
Holistic Monitoring
We regularly assess for extra-articular manifestations — uveitis, IBD, psoriasis, and cardiac involvement — ensuring whole-body care for AS.