Dr. Abhijeet Bhosikar

Inflammatory Back Pain & Spondyloarthritis Treatment in Pune

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

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Ravet, Pimpri-Chinchwad · OPD Mon, Wed, Fri

A therapist's hands assessing a patient's lower backIllustrative

Overview

What this group of conditions has in common

Spondyloarthritis is inflammation of the spine, the sacroiliac joints and the entheses — the points where ligaments and tendons anchor into bone. It typically begins between the late teens and the mid-thirties.

It is the most commonly missed diagnosis in rheumatology. Back pain in a young adult is assumed to be posture, a gym injury or a bad mattress, and the average delay to diagnosis runs to years. The pattern that gives it away is simple and specific: gradual onset, pain in the second half of the night, more than 30 minutes of morning stiffness, better with exercise and no better with rest.

MRI of the sacroiliac joints shows inflammation years before an X-ray changes, which means treatment can start while the spine is still fully mobile.

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

Recognising it

The clues that point to this group

Pattern recognition does more diagnostic work in rheumatology than any single test. These are the features that matter here.

  • Night pain that wakes you

    Waking at 3 or 4 am with back pain, and needing to move around before it settles, is the classic history. Mechanical pain does not usually do this.

  • Alternating buttock pain

    Pain that shifts from one side to the other points to sacroiliac inflammation rather than a disc.

  • Enthesitis

    Heel pain at the Achilles insertion or under the sole, or tenderness at the elbow and chest wall, are inflammation at tendon insertions — a hallmark of this group.

  • Extra-articular clues

    Recurrent painful red eye, psoriasis, or chronic diarrhoea and blood in stool. Each shifts the probability sharply and each changes which drug is chosen.

Investigation

The tests that separate these conditions

Only the investigations that answer a specific question — plus the safety screening required before any immunosuppression.

  • MRI sacroiliac joints

    STIR sequences show bone marrow oedema years before X-ray change — this is what allows early diagnosis.

  • HLA-B27 typing

    Interpreted strictly in context. Common in the Indian population; positive without inflammatory symptoms means very little.

  • X-ray sacroiliac and spine

    Detects established sacroiliitis, vertebral squaring and syndesmophytes.

  • CRP and BASDAI/ASDAS scoring

    Objective disease activity — what guidelines and insurers use to justify biologic therapy.

Treatment

How this is treated, step by step

A defined sequence with a defined review point at each stage — not an open-ended prescription.

  1. 01

    Establish the pattern

    ASAS-criteria assessment of inflammatory back pain, spinal mobility measurement and chest expansion.

  2. 02

    Daily structured exercise

    Extension, rotation and deep-breathing work. This is not an adjunct — done consistently it preserves posture and chest expansion measurably.

  3. 03

    Continuous NSAIDs

    Regular full-dose rather than on-demand, with gastric and renal protection planned alongside.

  4. 04

    Biologic therapy

    TNF or IL-17 inhibitors for disease that fails two NSAIDs. Choice guided by any history of uveitis or inflammatory bowel disease.

  5. 05

    Protect the bone

    Spondyloarthritis paradoxically causes osteoporosis. DEXA, vitamin D and fall precautions matter — a fused spine fractures easily.

Conditions in this group

3 conditions treated under spondyloarthritis & back pain

Each has a full patient guide covering symptoms, diagnosis, treatment and the warning signs that need urgent attention.

  • Spondyloarthritis

    Ankylosing Spondylitis

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

    Read the guide
  • Spondyloarthritis

    Psoriatic Arthritis

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

    Read the guide
  • Spondyloarthritis

    Reactive Arthritis

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

    Read the guide

Do not wait for an appointment if you have

  • Sudden 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 and TB must be excluded

Call the clinic on +91 70571 19999 or attend the nearest emergency department.

Questions

FAQs — spondyloarthritis & back pain

I am HLA-B27 positive. Do I have ankylosing spondylitis?
Almost certainly not on that basis alone. HLA-B27 is common in the general Indian population and only a small minority of positive individuals develop spondyloarthritis. Without inflammatory back pain or other features, a positive result needs no treatment and no repeat testing.
Will my spine fuse?
Complete fusion is now uncommon in patients treated early who exercise consistently. Modern biologics plus daily exercise have made severe deformity far rarer than the textbook images suggest.
Is exercise safe if my back already hurts?
It is the single most important part of treatment. Swimming is ideal — extension, rotation and cardiovascular work without impact. A physiotherapist should set the initial programme rather than starting alone.

Also treated

Other treatment areas

Get a specialist opinion on spondyloarthritis & back pain

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

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