Dr. Abhijeet Bhosikar
Spondyloarthritis

Ankylosing Spondylitis — Treatment in Pune

Also known as: Axial Spondyloarthritis · AS · axSpA

The back pain that improves with exercise and worsens with rest — and is missed for years.

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What is Ankylosing Spondylitis?

Ankylosing spondylitis is a chronic inflammatory arthritis that targets the sacroiliac joints and spine. Inflammation at the entheses — where ligaments and tendons anchor into bone — is followed by new bone formation, which can eventually fuse spinal segments.

It typically begins in the late teens to early thirties, and it is the classic cause of back pain in a young adult that gets dismissed as a gym injury or a bad mattress for five to ten years.

The distinguishing feature is inflammatory back pain: gradual onset, worse in the second half of the night, more than 30 minutes of morning stiffness, better with movement and no better with rest.

A swimmer mid-stroke in a pool laneIllustrative
Swimming is the single best exercise in ankylosing spondylitis: extension, rotation and cardio without impact.

In the Indian context

COPCORD data put spondyloarthritis prevalence in India at roughly 0.23%. HLA-B27 is common in the general Indian population, so testing positive without inflammatory symptoms is not a diagnosis — a point of frequent and expensive confusion.

Symptoms of Ankylosing Spondylitis

Early signs

  • Low back and buttock pain before age 40, developing gradually over months
  • Pain and stiffness worst on waking or after prolonged sitting; better after a hot shower or activity
  • Alternating buttock pain that shifts from side to side
  • Heel pain at the Achilles insertion or under the sole (enthesitis)
  • A swollen finger or toe that looks like a sausage (dactylitis)

If left untreated

  • Reduced spinal flexion, chest expansion below 5 cm, and stooped posture
  • Neck stiffness and difficulty looking over the shoulder while driving
  • Recurrent painful red eye with light sensitivity (acute anterior uveitis)
  • Associated inflammatory bowel disease or psoriasis
  • Osteoporotic spine fracture from relatively minor trauma

Causes & risk factors

  • HLA-B27 positivity — present in 80–90% of patients, though most B27-positive people never develop the disease
  • Family history of AS, psoriasis, uveitis or inflammatory bowel disease
  • Gut mucosal inflammation and microbiome changes driving joint inflammation
  • IL-17 and IL-23 immune pathway activation
  • Male sex — men tend to develop more radiographic fusion, though women are affected as often and are diagnosed later

How Ankylosing Spondylitis is diagnosed

No single test diagnoses a rheumatic disease. The diagnosis comes from combining the pattern of symptoms, the examination findings, and only the investigations that answer a specific question.

  1. Inflammatory back pain assessment

    A structured history using ASAS criteria — age of onset, night pain, morning stiffness duration, response to exercise versus rest — carries more diagnostic weight than any blood test.

  2. MRI of the sacroiliac joints

    STIR sequences show bone marrow oedema years before X-ray changes appear. This is what allows non-radiographic axial spondyloarthritis to be diagnosed and treated early.

  3. X-ray sacroiliac joints and spine

    Detects established sacroiliitis, squaring of vertebrae and syndesmophytes. Normal X-rays do not exclude early disease.

  4. HLA-B27 typing

    Interpreted strictly in context. It raises probability substantially in a patient with inflammatory back pain, and means little in a patient with mechanical pain.

  5. CRP, ESR and BASDAI scoring

    Objective baselines. BASDAI and ASDAS scores are what guidelines and insurers use to justify escalation to biologics.

  6. Screening for extra-articular disease

    Eye, skin and bowel review at every visit, since uveitis, psoriasis and IBD change the choice of drug.

Treatment options

Daily structured exercise — the foundation

Spinal extension, rotation and deep-breathing exercises done consistently are as important as medication. Physiotherapy-led programmes measurably preserve posture and chest expansion.

NSAIDs taken continuously, not on demand

In AS, regular full-dose NSAIDs are both symptomatic and possibly structure-modifying. Gastric and renal protection is planned alongside.

Biologic therapy

TNF inhibitors and IL-17 inhibitors such as secukinumab and ixekizumab transform disease that fails two NSAIDs. Choice is guided by uveitis or IBD history.

JAK inhibitors

Oral upadacitinib and tofacitinib are approved options for active axial disease.

Targeted enthesitis and peripheral joint care

Local injections for persistent enthesitis; sulfasalazine or methotrexate where peripheral joints dominate — neither helps axial disease.

Bone health and posture protection

AS paradoxically causes osteoporosis. DEXA scanning, vitamin D, calcium and fall precautions matter, because a fused spine fractures easily.

Living with Ankylosing Spondylitis

  • Sleep flat on a firm mattress with a thin pillow; avoid curling into a foetal position
  • Set the monitor at eye level — office posture accelerates cervical stiffening
  • Swimming is the single best exercise for AS: extension, rotation and cardio without impact
  • Stop smoking — it is strongly linked to faster spinal fusion and worse function
  • Practise deep breathing daily to maintain chest wall expansion

Seek urgent medical attention if you have

  • Sudden new severe neck or back pain after even minor trauma — a fused spine fractures unstably
  • A red, painful, light-sensitive eye — see an ophthalmologist the same day
  • New leg weakness, numbness, or bladder or bowel changes
  • Persistent fever and weight loss — spinal infection or TB must be excluded, especially in India
  • Chronic diarrhoea or blood in stool suggesting inflammatory bowel disease

Do not wait for a scheduled appointment for any of the above. Call the clinic on +91 70571 19999 or attend the nearest emergency department.

Frequently asked questions about Ankylosing Spondylitis

I am HLA-B27 positive. Will I get ankylosing spondylitis?
Most likely not. HLA-B27 is a susceptibility marker, not a diagnosis; only a small minority of positive individuals ever develop spondyloarthritis. Without inflammatory back pain or other features, a positive result needs no treatment and no repeat testing.
Will my spine definitely fuse?
No. Complete fusion — 'bamboo spine' — is now uncommon in patients treated early who exercise consistently. Modern biologics plus daily exercise have made severe deformity far rarer than textbook images suggest.
Why does my back hurt more when I rest?
That is the hallmark of inflammatory rather than mechanical back pain. Inflammatory mediators accumulate during immobility overnight, which is why patients wake at 3–4 am and feel better after moving around.
Can I go to the gym?
Yes, and you should. Emphasise extension, mobility and core stability; avoid heavy axial loading and high-impact contact sports if the spine is already fused. A physiotherapist should set the initial programme.

Get an expert opinion on Ankylosing Spondylitis in Pune

Consultations at the Ravet clinic in Pimpri-Chinchwad. Bring your previous reports — a properly reviewed history usually saves repeating tests.

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Part of a wider group

Spondyloarthritis & Back PainBack pain that is worse at rest and better with movement is not a mechanical strain.

Related conditions

  • Psoriatic Arthritis

    When psoriasis moves into the joints — often years after the first skin patch.

  • Reactive Arthritis

    Arthritis that follows an infection elsewhere — usually self-limiting, occasionally not.

  • Osteoporosis

    Silent until the first fracture — which is exactly why it should be screened for, not waited for.

  • Rheumatoid Arthritis

    Symmetric small-joint swelling that responds best when treated within the first 12 weeks.

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