On the occasion of World Ankylosing Spondylitis (May 4), let me throw some light on the not so popular disease, but the one that causes irreparable damage if left untreated or undiagnosed- Ankylsoing spondylitis. 

It is a type of arthritis which affects the spine causing ankylosis (stiffening of joint or loss of mobility). The exact cause of this disease is unknown. But AS is an autoimmune disease in which our body’s own immune system is misdirected to attack its own organs and cause disease. HLA B27 is the genetic risk factor for AS. People with HLA-B27 are more likely to have this form of arthritis than those without the gene.

It usually begins in adolescents/young adults. One in 100 adults in India are diagnosed to have AS. Approximately 50 -60 lakh Indians are suffering from AS. One in 10 patients that a Rheumatologist sees in his clinic are patients with AS. Many are still left undiagnosed and untreated and never make it to the statistics!

World Ankylosing Spondylitis Day By Dr C Balaji

It usually affects young men between 20-45 years of age. Close family members of patients with AS are also at a higher risk.

Main symptom of AS is low back pain. Back pain is a common problem in the digital era. It is important to understand the difference between the regular back pain and the back pain of AS.

Back pain of ankylosing spondylitis usually is severe at rest and it decreases with physical activity. It is more severe in the nights and is associated with a stiff back early in the morning which usually lasts more than 30 minutes.

If someone has back pain similar to the above description they need to be screened for AS!  AS can also causes joint pains usually in the lower limbs. Heel pain, sole pain are also common. Untreated AS can also affect the eyes, heart, kidneys, bowels and also lead to weak bones or osteoporosis and ultimately fractures.

Rheumatologists are the experts who treat AS. Rheumatologist assess the patients’ medical history, examines the spine, joints etc. and based on the clinical scenario orders for Xray of sacroiliac joint ± spine or MRI to make a diagnosis. HLA B27 genetic testing may also be ordered as a part of work up.

At present there is no cure for AS. But early treatment relieves symptoms and prevents rapid progression of disease. But the sad state of affairs in our country is that many patients ignore the back pain or are unaware that they need to consult a Rheumatologist for AS.

Due to lack of awareness, most patients end up getting treated by other specialists and present in late stages to Rheumatologist when the disease has already caused irreparable damage.

The first line of treatment are the pain killers. Steroids and conventional disease modifying drugs like methotrexate usually prescribed in rheumatoid arthritis have no proven role in relieving spinal symptoms of AS. Regular physiotherapy tailored to the patients’ needs also forms an integral part of the treatment.

Biologics are the latest medications which have revolutionized the treatment of AS. Biologics are popular all over the globe for treatment of AS. However, they are expensive. Cost of these drugs could range from 25,000 rupees to lakhs of rupees a month depending on the biologic chosen for treatment. Biologics are usually not being covered under insurance in India.

This trend has to change. The government and insurance companies must include these life changing drugs under insurance as most patients with AS are the breadwinners for their family and are dependent on these drugs to have a normal life like all. Many a time we find that our patients have difficulty to adhere to international standard of treatment due to financial constraints.

Salient Points

Never Ignore Back Pain

Never Delay, Consult Rheumatologist At The Earliest

Adhere To The Treatment Plan

Dr C Balaji, is a Consultant Rheumatologist, Parvathy Hospital, Chennai