Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that affects the spine and pelvis (sacroiliac joints) — causing stiffness, pain, and over time, fusion of joints. It typically begins in young adults (usually men) in their late teens to 30s. Diagnosis is often delayed in India by 5-10 years — a pattern worth breaking.

Key features — suspect AS when

• Inflammatory back pain — young adult; gradual onset; morning stiffness over 30 minutes; improves with activity, worsens with rest; waking in the second half of the night with back pain.
• Alternating buttock pain.
• Peripheral arthritis — knee, ankle.
• Enthesitis — heel pain (Achilles, plantar fascia).
• Dactylitis — sausage digit.
• Eye inflammation (anterior uveitis) — painful red eye, sensitivity to light; urgent eye review.
• Fatigue, low-grade fever, weight loss.
• Associated IBD, psoriasis.

Diagnosis

• HLA-B27 — positive in most; supports diagnosis.
• MRI of sacroiliac joints and spine — shows active inflammation early (X-rays may be normal initially).
• Inflammatory markers (ESR, CRP) — often raised.
• Rule out TB of the spine — important in India; deep back pain + night sweats + weight loss + constitutional symptoms → imaging + TB work-up.

Treatment

• Regular exercise and posture work — the single most important daily habit; prevents fusion in a bad position.
• Physiotherapy — spine flexibility, rib-cage expansion, core strength.
• NSAIDs — first-line for pain; may need regular use for control.
• Biologics (TNF inhibitors, IL-17 inhibitors) — for active disease not controlled by NSAIDs; widely available in India; transformative.
• DMARDs for peripheral joint disease — where hands/feet are also involved.
• Treat uveitis urgently (ophthalmologist).
• Don't smoke — smoking worsens AS substantially.
• Vaccines, bone health, cardiovascular risk — manage alongside.
• Surgery — rarely, for spine correction or hip replacement when joints fuse in a bad position.

A young adult with persistent back pain, especially morning stiffness and pain at night, deserves HLA-B27 + MRI — not years of painkillers for "lumbago." Early diagnosis and modern treatment let most people with AS live active, essentially unlimited lives.