Ankylosing Spondylitis means inflammation of the spine causing pain and stiffness of the back. When ankylosing spondylitis is not treated, it leads to a stiff spine called a ‘bamboo spine’. This leads to significant physical disability interfering with performance of even daily activities, work unemployment, work absenteeism and mental depression.

The basic cause of ankylosing spondylitis is that the body’s defence system attacks its own spine, leading to inflammation and fusion of the spine. Ankylosing spondylitis usually has its onset in the age group between 20 years to 30 years and is more in males than females. The reported prevalence of ankylosing spondylitis is around 0.83% in the Indian population.

The clinical symptoms of ankylosing spondylitis are pain in the low back or buttocks which is worse in the night and after getting up in the morning. The low back stiffness lasts for nearly 30 minutes. The back becomes less flexible and people with ankylosing spondylitis find it difficult to even bend forward and wear their socks and shoes.The pain and stiffness become better with activity.

Clinical examination reveals restricted spinal movements and decreased chest expansion. Investigations that are helpful to confirm the diagnosis are: blood tests, radiographs and MRI scans of the lumbar spine and pelvis.

Treatment of ankylosing spondylitis requires a holistic approach which comprises medications, physiotherapy and exercise, lifestyle modification, patient education and surgical intervention. The goal of treatment is to confer maximal mobility of the spine and joints affected with minimal pain. Medications comprise nonsteroidal anti-inflammatory drugs (NSAIDS; pain relievers) and biologics. Nonsteroidal anti-inflammatory drugs confer adequate pain relief, but long-term usage is associated with gastrointestinal side effects and renal toxicity. At present, the best medicines for treating ankylosing spondylitis are “Biologics”.  

Biologics are genetically engineered proteins which are designed to block certain aspects of the immune system in our body which are responsible for the inflammation and fusion of the spine in ankylosing spondylitis. Biologics not only reduce pain and improve physical mobility but they retard the radiological progression of the disease. The rheumatologist will discuss the advantages and side effects of these biologics during the consultation with the patient.

Physiotherapy forms the sheet anchor in the treatment of ankylosing spondylitis.  Regular stretching, muscle strengthening and breathing exercises will improve the pain and flexibility of the joints. Swimming and hydrotherapy are rewarding. Correct posture maintenance while standing at work and sleeping is important. One should avoid using pillows and sleep either on the chest or on the back. The mattress should be firm and provide enough support to prevent any tendency for the spine to be bent. There is no specific diet and a well-balanced diet should be taken to achieve the ideal body weight. Smoking and alcohol should be avoided. A patient also needs physical and emotional support from the family and friends.

The outcome in ankylosing spondylitis is very encouraging if diagnosed and treated early with good cooperation from the patient with respect to exercises and lifestyle modification. Patients with ankylosing spondylitis require referral to the rheumatologist. After all, “Life is mobility and Mobility is life”.