Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory arthritis, in which mainly joints of spine and the sacroliliac joint, which is in the pelvis (waist bone), are affected. This can result into fusion of spine. It is a type of spondyloarthritis, meaning arthritis of vertebral column. But it may also involve peripheral joints and also non-articular structures. Fusion of spine leads to total rigidity of spine, which is called ‘bamboo spine’. AS is incurable; however medicines and treatments can reduce the severity of symptoms and pain, and sometimes nutritional and lifestyle modifications can bring about complete cure too.


Symptoms of AS start showing slowly, generally at about 23 years of age. To start with, there is pain and stiffness in the middle portion of spine or full spine. This is often accompanied by pain in one of the buttocks or back of thigh from sacroliliac joint. These symptoms are not characteristic to AS and so till diagnosis, a long time passes, usually 8 to 11 years. Another common symptom seen in about 40% of patients is uveitis (inflammation of inner eye), which causes redness, pain, loss of vision, floaters (small objects seen floating before eye) and photophobia (discomfort because of light). If the patient suffers from the disease before the age of 18, it is quite likely to give pain and swelling in large limb joints, especially in knee and also in ankles and feet if the child is still younger. General fatigue and nausea is also quite common. Pain is sometimes relieved with physical actions; however, many patients feel continuous pain and swelling despite movement or rest.


Treatment for ankylosing spondylitis essentially contains physiotherapy and exercise, together with medicines. Good news is there are reports of complete recovery after dietary and lifestyle modifications. To start with, a physician always prescribes medication to relieve pain and inflammation. Exercise and physiotherapy is given later. This is because exercise to an already inflamed and painful joint can only increase pain. Ankylosing Spondylitis Doctors often advise to keep good posture in order to reduce chances of fused spine, which is common in majority of patients.


Pain relievers are essential part of the initial treatment for AS, in order to slow down the progression of the disease. These are of two types, viz. anti-inflammatory drugs (NSAIDs) and opioid analgesics. The former is a drug of choice of doctors as many patients are actually benefitted with their continuous use. The later can cause addiction and therefore is not usually prescribed. Disease-modifying antirheumatic drugs (DMARDs) (e.g. cyclosporine, sulfasalazine, methotrexate and corticosteroids), TNF-blockers (e.g. biologics etanercept, golimumab, infliximab and adalimumab) and anti-interleukin-6-inhibitors (e.g. tocilizumab and rituximab) are some new drugs.


If the case is severe, surgery is often recommended. Joint replacement usually in knees and hips are performed. Even surgical connection can be done in patients having severe flexion distortion.


Physiotherapies which benefit ankylosing spondylitis patients the most include: