India is home to the world’s second largest population, with rheumatological disorders affecting 6 per cent to 24 per cent of the population. However, certain chronic rheumatological conditions like Ankylosing Spondylitis are becoming increasingly prevalent in India, largely affecting the millennial population.
Ankylosing Spondylitis (AS) is an irreversible, inflammatory and autoimmune disease that affects the joints of the spine and of the lower limbs. Also known as ‘arthritis of the spine,’ it occurs when an overgrowth in the spine’s bones causes them to fuse together to form a rigid spine. Prevalent amongst one in 200 to 500 of the adult population, AS more commonly affects young men, especially in their teens and between their early twenties and thirties.
The condition which affects men during the most active and productive years of their lives, can lead to ‘structural damage progression.’ This means, if the condition is left untreated and undiagnosed, it can severely disrupt mobility, cause damage to posture, which can bend the spine and neck to an extent that it may become impossible for one to lift their head high enough to see forward. In some cases, patients can become wheelchair bound.
Signs: Key signs include pain during early mornings, especially 30-45 minutes after waking up which can last upto several weeks or more despite taking painkillers. AS is generally diagnosed through physical examination, X-Ray, MRI and a series of blood tests.
Most people with AS have a gene called HLA-B27 which can be detected by a blood test. While this gene is not the absolute cause of Ankylosing Spondylitis, it can contribute to it. Also, if one has this gene, it does not necessarily mean that the person would definitely be affected by AS.
Treatment: Painkillers, anti-inflammatory drugs and steroids are prescribed by doctors to ease inflammation and accompanying pain. While commonly used painkillers help reduce pain, they provide short-term relief. Medical experts also recommend newer and advanced treatment options like biologics, that help slow down structural damage progression and aim at preventing bone fusion, which could be disabling. Many patients are on treatment with biologics and this has changed the treatment paradigm from simple anlfesic and painkillers to definitive therapy that reduces the disease’s march.
AS is mistaken for regular spondylitis or general back pain and therefore leads to delayed diagnosis among the patients.
Apart from the prolonged, physical burden, AS can also have serious emotional repercussions on the patients.
It is advisable that patients should visit a rheumatologist with necessary blood reports sooner rather than later.
Management: In addition to medical treatment, self-help and maintaining a healthy lifestyle is equally significant for the management of AS. Patients are advised physiotherapy, hydrotherapy, exercise and posture modification to improve their quality of life.
They should also maintain a healthy dietary regimen, as gut and urinary infections might cause flare ups of AS. Patients are also advised to avoid smoking and consumption of tobacco.
The writer is Dr Sundeep Upadhyaya MD,DM, Sr Consultant Rheumatology,ImmunologyIndraprastha Apollo Hospitals, New Delhi