Ankylosing Spondylitis diagnosis & treatment in Bhubaneswar
Ankylosing spondylitis is a chronic inflammatory arthritis that mainly affects the spine and sacroiliac joints, causing back pain, stiffness and reduced mobility.
What is ankylosing spondylitis?
an inflammatory spine disease
Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory arthritis that primarily affects the spine and sacroiliac joints, leading to stiffness, pain and reduced mobility.
- Over time, inflammation may lead to fusion of the spinal vertebrae, sometimes forming a characteristic “bamboo spine”.
- The main problem is back pain — it usually starts in the lower back and becomes gradually worse over several months.
- Pain and stiffness are typically worst first thing in the morning and tend to ease with activity and exercise as the day goes on.
- Besides the spine, it can affect other joints such as the hips, knees, ankles and shoulders, and can inflame the eyes.
Signs & symptoms
what AS feels like
- Usually it presents with difficulty getting up from bed, pain while turning in bed late at night and alternating buttock pain.
- The main problem is back pain. The pain usually starts in the lower back and becomes gradually worse over several months. You may have pain over your buttocks and down the back of your thighs.
- A person suffering from AS may have difficulty going to the toilet, bending forward to lift an object, or moving the neck in the morning.
- The stiffness can be quite severe first thing each morning. It usually improves with activity and exercise, and tends to ease as the morning goes on.
- Other joints may be affected, such as the hips, knees, ankles and shoulders. Affected joints can become painful, stiff and swollen.
- Tendons and ligaments in various parts of the body may become inflamed and painful where they attach to bones — this is called enthesitis.
- Inflammation of the eye can occur in about 20 per cent of these patients, which is known as uveitis. Urgently see a doctor if you have AS and develop a painful or red eye.
- Many a time, untreated inflammation causes joint deformity, making the patient bedbound.
Watch: more on ankylosing spondylitis from OARC (opens YouTube)
Back pain and morning stiffness that improve with exercise but not rest? See a rheumatologist early — with proper treatment from an early stage, the spinal fusion AS causes can be prevented.
Book AppointmentWhat causes
ankylosing spondylitis?
- Ankylosing spondylitis is an autoimmune disease in which there is inflammation of the joint synovium because of an immune attack.
- Normally our immune system attacks outside invading organisms like bacteria and viruses, and is designed to protect our own body parts, like the joints. In AS, the immune system becomes dysregulated and attacks one’s own joints. Although it is not completely known why this happens, multiple factors contribute — genes, environment and infection.
- There is a strong hereditary (genetic) tendency. There is a strong association with a gene called HLA-B27 — about 9 out of every 10 people with AS have this gene, compared with less than 1 out of every 10 in the general population.
- However, having only the HLA-B27 gene does not mean you will automatically develop AS. Most people with this gene do not develop the disease.
- Some people develop AS without having the HLA-B27 gene. It is thought that infections or other environmental factors may trigger AS in people with a genetic background such as HLA-B27.
Ankylosing spondylitis
at a glance
Because some genetic factors like HLA-B27 are responsible for AS, this may run in families.
Rheumatologists are the specialists who are trained to treat this disease.
How ankylosing spondylitis
is diagnosed
AS is mainly diagnosed by a trained rheumatologist — it should never be diagnosed on a blood test alone.
AS is mainly diagnosed by a trained rheumatologist or physician by taking a complete symptom history and a good clinical examination. It should not be diagnosed based upon a blood test alone.
HLA-B27 testing may increase the probability of someone having AS, but not everyone who is HLA-B27 positive has AS. Testing should be done with proper rheumatology consultation — some healthy people are positive without the disease, while about 1 in 10 AS patients have negative results yet still suffer from AS.
X-ray is helpful in detecting inflammation in the sacroiliac joints. In early cases the X-ray may look normal, so your doctor may ask for an MRI, which picks up early inflammatory changes in the sacroiliac joints and confirms a diagnosis of AS.
Some blood tests are ordered to monitor the effects of prescribed drugs. These include Complete Blood Count (CBC), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Liver Function Test (LFT) and Kidney Function Test.
How ankylosing spondylitis
is treated
Exercise — the foundation
Exercises like swimming or cycling form the major part of treatment for AS patients, as they prevent fusion of the bones and maintain mobility. Staying active is central to keeping the spine supple.
NSAIDs — first-line medication
You may be prescribed painkillers (NSAIDs), which often have to be continued for many months, as they are the first-line treatment for most AS patients.
Individual response & supervision
All patients are different — some respond well to a particular drug while others feel no benefit, and some drugs can cause severe gastritis or other complications in one person yet none in another. Because drug response and side effects vary, treatment has to be continued under the supervision of a trained rheumatologist, who periodically monitors your blood tests to look for side effects.
DMARDs
The drugs known as DMARDs (Disease Modifying Antirheumatic Drugs) include Methotrexate, Sulfasalazine, Hydroxychloroquine and Leflunomide. They are particularly useful for knee or ankle joint swelling, but not for upper or lower back problems. Taken properly under supervision, they help control joint inflammation and give the patient a normal life.
Biologic drugs
Biological drugs are new drugs that target specific molecules like TNF and other cytokines such as IL-17 which incite inflammation in AS. They are very effective but, because of high costs, are usually given after failure of other drugs. Biologics effective in AS include Etanercept, Adalimumab, Infliximab, Golimumab and Secukinumab.
Care at OARC
Review visits with the OARC rheumatology team run Monday to Saturday, 9:00 AM–2:00 PM and 4:30–9:00 PM. Call +91 93386 53086 or book online.
How OARC Can Help?
At OARC, we offer holistic care to patients suffering from all kinds of arthritis and autoimmune diseases by our renowned rheumatologists. Because of the chronic nature of the disease, we spend time with the patient helping them to know about their disease, and demystify the myths regarding the disease and treatment. We have collaboration with an NABL accredited laboratory where all kinds of blood tests can be done at reasonable costs. We also have a patient support system which patients can approach in case of any emergency. We believe in a friendly relation with patients so that they can share all their sufferings and get the best possible treatment.
- Best doctors to treat
- State-of-the-art clinic
- All facilities available under one roof
- NABL accredited laboratory
- Same-day test results
- Convenient location
What happens if AS
is left untreated?
- With proper treatment, an ankylosing spondylitis patient can lead a normal life without pain and deformity.
- But if not treated properly from an early stage, there may be fusion of the bones, leading to loss of natural movement and severe joint deformity.
- It may increase the risk of heart attack.
- The hip joint may fuse, so the patient becomes unable to walk or sit and may require joint replacement therapy.
Questions to ask your doctor
- Which medicines are right for me, and how long before they start working?
- What exercises should I do to keep my spine mobile and prevent fusion?
- How often will my blood tests be monitored while on treatment?
- What should I do if I develop a painful or red eye?
- What are my chances of a normal life with treatment?
Frequently Asked Questions
arthritis care in Odisha
Meet the rheumatologist
behind your care
Dr. Jyoti Ranjan Parida
Founder & Lead Rheumatologist at OARC. Dr. Parida pioneered specialist rheumatology care in Odisha since 2014 and leads the OARC rheumatology team — with fellow rheumatologist Dr. Debashis Maikap — at our Bhubaneswar centre. Consultations run Monday to Saturday, 9:00 AM–2:00 PM and 4:30–9:00 PM.