Medically guided Dr. Devender Bairwa, Consultant Rheumatology & Clinical Immunology, says:
“Rheumatic and autoimmune conditions can affect much more than the joints. Early diagnosis, appropriate treatment, and regular monitoring are essential to control inflammation, prevent long-term joint damage, and help patients maintain mobility and quality of life. Every patient requires an individualized treatment plan based on their symptoms, clinical findings, and disease activity.”
What Is Ankylosing Spondylitis?
Ankylosing spondylitis is a chronic type of inflammatory disease that manifests as inflammation of the back and various joints (particularly those connecting lower back with pelvis area, known as sacroiliac joints). Being a type of axial spondyloarthritis, this type of disease has some other features characteristic of diseases in this category including inflammation resulting in lower back pain and discomfort. Some people may also have problems with other parts of the body caused by the condition such as skin, eyes, tendons and intestines.
The disease usually appears in kids and therefore young adults can develop the disease at that stage of life.
Pain associated with the condition is believed to be different from normal back pain of non-infectious character because it develops according to a specific scheme. Such pain usually occurs after sleeping or in the morning and is usually alleviated after physical activity.
This is why young people who are experiencing the pain may think it has something to do with physical activities, incorrect posture, or uncomfortable mattress.
Inflammatory Back Pain vs Mechanical Back Pain
Recognizing the difference between mechanical pain and inflammatory pain helps patients determine when to consult a doctor.
Mechanical pain
Mechanical pain is typically associated with the physical strain and changes in the spine structure. Mechanical pain tends to worsen while performing certain movements and lifting or remaining in a particular position.
In some instances, rest might be beneficial.
Inflammatory pain
Inflammatory pain has the following common features:
- It typically affects younger people.
- It develops gradually over time rather than as a result of a sudden injury.
- In the morning, patients can experience stiffness for a period of time.
- After resting for a long time, they feel pain or stiffness.
- Physically active individuals often notice pain in their hips.
- Patients can experience pain at night.
The above signs do not indicate that a patient suffers from ankylosing spondylitis, however, their presence might require further investigation.
Why Does Ankylosing Spondylitis Develop?
It is not fully known what causes ankylosing spondylitis. Genetics and immune system factors seem to play a role.
One of the most known genetic links is HLA-B27.
HLA-B27 is a genetic marker associated with higher risk of axial spondyloarthritis and similar conditions. However, the presence of HLA-B27 does not automatically mean that an individual has ankylosing spondylitis.
Many individuals with HLA-B27 do not get the disease. Likewise, there are patients with ankylosing spondylitis who do not have HLA-B27.
Thus, an HLA-B27 test should never be a standalone test for the diagnosis of the disease in question.
What Is HLA-B27 Arthritis Care?
People who are searching for HLA-B27 arthritis treatment must have questions that arise once they get a positive HLA-B27 test.
First, one must know that an HLA-B27 test is not a diagnosis, but it is just a risk factor.
The rheumatologist may consider the HLA-B27 test results along with:
- Presence of symptoms and how long they last
- Pattern of back pain
- Physical examination
- Family history
Tests for inflammation in the blood;
- X-rays
- And other tests.
Common Symptoms of Ankylosing Spondylitis
The signs might vary from one individual to another.
Pain in the lumbar spine and the buttocks
The pain may be coming from the lower back or the buttocks and might move from one side to another in some cases.
Stiffness on waking
Individuals might find themselves being stiff when they wake up and struggling to move.
Pain that improves during exercise
It is among the signs that will assist in distinguishing the inflammatory pain from mechanical diseases. In some instances, light exercise might improve the condition.
Pain at night
Some people may experience pain or stiffness of their bodies at night or even during the morning.
Symptoms involving the knee or hip joints
There might also be inflammation of some patients’ peripheral joints.
Pain in the heel
There might be some heel or foot pain resulting from inflammation of the ligaments or tendon where it is attached to the bone; the name of the disease in this case is enthesitis.
Fatigue
Persistent inflammation might lead to weakness and fatigue.
All the people who have the diagnosis of this disease might not have these symptoms, and the signs might vary over time.
Symptoms Outside the Spine
Ankylosing spondylitis does not necessarily affect only the spine.
Some people can have what is called uveitis, which causes symptoms like eye pain, redness, light sensitivity, or even blurred vision.
There can be other conditions of the skin, including psoriasis, or inflammatory bowel disease of the digestive tract.
A thorough medical history will assist the rheumatologists to identify the overall pattern of the disease.
Medical attention should be sought immediately if there is a sudden onset of red eye with light sensitivity.
How Is Ankylosing Spondylitis Diagnosed?
There is no one test that provides a definitive diagnosis of ankylosing spondylitis.
Diagnosis generally involves combining the findings from the clinical assessment with blood tests, imaging studies, and the patient’s medical history.
Medical history and examination
In taking a medical history, the doctor will inquire:
- Onset of symptoms
- Duration of back pain
- Morning stiffness
- Symptoms at night
- Effect of movement on pain
- Family history
- Swelling in joints
- Pain in the heels
- Eye inflammation
- Skin or bowel symptoms
Blood tests
Blood tests like C-reactive protein (CRP) tests and erythrocyte sedimentation rate (ESR) tests are useful in detecting inflammation in the body. Nevertheless, normal test results do not eliminate the possibility of having axial spondyloarthritis.
It is also customary to check for presence of HLA-B27 in patients suspected of the disease.
Imaging
In established cases, X-rays can detect the structural long-term changes in the disease. MRI is very useful in detecting inflammatory processes at early stages in particular in areas of sacroiliac joints.
The type of imaging will depend on the current situation and condition of the patient, findings from the previous investigations conducted by the treating physician.
Why Early Diagnosis Matters
An issue that is common among people suffering from ankylosing spondylitis is the fact that the symptoms at the beginning stages may not be severe.
One could go ahead and continue with work, studies, or sports thinking that the pain is just due to poor posture or overexertion of oneself.
The symptoms might take a long period, sometimes months or even years, before any form of treatment is started.
At an early stage, the physician will be able to diagnose and assess the level of inflammation, administer medication, and monitor the progress made.
It is important that people who require ankylosing spondylitis treatment in Delhi should consult a doctor once they realize that their chronic pain is due to inflammation.
Ankylosing Spondylitis Treatment in Delhi: What Does Treatment Involve?
Not only is the goal of therapy to reduce the pain temporarily. The focus of the treatment is on the inflammation management, the spine motion protection, and everyday functioning while prevention and/or reduction of the chronic consequences.
As the therapy is individual for each patient, the program of treatment is designed on the basis of the degree of the disease activity, symptoms of the patient, X-ray examination, coexisting diseases, and the general health condition of the patient.
Physical exercises and physiotherapy
Physical exercises play an important part in the treatment of axial spondyloarthritis.
Physiotherapist can provide a set of physical exercises designed for:
- Spine mobility
- Posture
- Flexibility
- Lung vital capacity
- Cardio-respiratory endurance
The proper physical exercise program for the patient will allow the patient to reach his/her physical targets and keep his/her health.
However, physical exercises should be adjusted individually for the patient and illness in special cases of the flares-up.
Medications
Lastly, physicians may resort to using anti-inflammatory medications depending on the particular case. For patients with active disease despite the initial treatment, advanced therapy might be used under the direction of a specialist. Among these advanced therapies are biologics and targeted therapies, which require an appropriate evaluation, screening, monitoring, and follow-up by an experienced team of rheumatologists.
Lifestyle Measures
Good health is supportive of the management of diseases. For example, patients have to:
- exercise regularly
- reduce the time of inactivity
- achieve a healthy body mass index (BMI)
- stop smoking
- ensure proper sleep
- follow an individual exercise plan
Lifestyle measures make medical treatment more efficient, but they do not substitute any appropriate type of treatment in case of significant inflammation.
Can Ankylosing Spondylitis Be Cured?
Ankylosing spondylitis is seen as a chronic inflammatory disorder today instead of a disease that can be cured. Nevertheless, modern methods of treatment allow one to get help with alleviating symptoms of the disease and continue living a normal life. The goal of therapy is to achieve low activity of the disease, as well as remission, if possible, preserve the physical functions of the body and minimize the consequences of ongoing inflammation. Regular supervision is critical because the way the disease is manifested can be transformed with time.
Is Ankylosing Spondylitis Only a Disease of Men?
While it used to be believed that ankylosing spondylitis is a disease of men, it is now known that axial spondyloarthritis can be found in men and women alike.
Symptoms can vary from person to person, which may lead to postponed diagnosis.
As a result, chronic inflammatory back pain should be determined by different factors rather than male or female.
Can Young Adults Continue Exercise?
Physical activity is recommended most of the time.
Exercise helps improve mobility, strengthen muscles, maintain cardiovascular health, and improve well-being.
One must tailor the type of exercise to the degree of symptoms and disease activity. The rheumatologist or physical therapist can help create the exercise plan.
In case of an active flare, any strenuous and painful activities may be adjusted.
When Should You See a Rheumatologist?
Consulting is advisable when experiencing back pain:
- Begins with young age
- Lingers for several weeks or beyond the average duration
- Results in prolonged stiffness in the morning
- Worsens with inactivity and improves only with exercise
- Causes disturbed sleep
- Is associated with recurrent pain in the buttocks
- Accompanied by heel pain or joint swelling
- Associated with psoriasis, bowel diseases or eye irritation
- Has a family history of spondylarthritis
Conclusion
Back pain among young people should not be viewed simply as a result of posture or exercise or a lazy lifestyle. When pain has signs such as early morning stiffness, symptoms at night, and improvement after movement, it is necessary to investigate it further.
Ankylosing spondylitis is chronic inflammation which can affect spine, pelvis, or other parts of the body. Timely diagnosis of the disease and prompt and correct evaluation are necessary.
For those with ankylosing spondylitis treatment in Delhi, a consultation with rheumatology will allow to differentiate inflammatory back pain from the usual mechanical one and determine whether additional tests, investigation, or treatment is needed.
Dr. Devender Bairwa, Consultant Rheumatology & Clinical Immunology, has graduated from one of the most prestigious institutions in the country, such as AIIMS, JIPMER, and MAMC, and specializes in rheumatic diseases.
Young adults should not simply accept chronic back pain as part of life. It is crucial to identify the right red flags and thus protect their mobility and quality of life.
Frequently Asked Questions About Ankylosing Spondylitis
1. What is ankylosing spondylitis?
Ankylosing spondylitis is a long-term condition involving inflammation of the joints of the spine and pelvis. It is classified under axial spondyloarthritis.
2. What are the initial symptoms of ankylosing spondylitis?
Initial symptoms may comprise spinal pain and stiffness persisting for three months or longer, pain after being inactive, night pain, and improvement owing to physical activity.
3. Is it enough to have a positive HLA-B27 blood test for diagnosis of ankylosing spondylitis?
No. The HLA-B27 blood molecule is an indicator of a risk factor, but a positive test alone is not a diagnosis. Symptoms, examination, and additional findings are needed for proper diagnosis.
4. Can women develop ankylosing spondylitis?
Yes. Both men and women can get ankylosing spondylitis or axial spondyloarthritis.
5. Can ankylosing spondylitis be treated without surgery?
Yes. Treatment for ankylosing spondylitis usually consists of medication, exercise, physical therapy, and advanced treatment recommended by a specialist.
