By Prof. Dr. Jyoti Ranjan Parida

As we mark World Ankylosing Spondylitis Day on 03rd May 2025, it’s time to shine a spotlight on a frequently misunderstood cause of chronic back pain and help raise awareness among patients and healthcare providers alike.

Back pain is one of the most common medical complaints globally. For most people, it’s a temporary discomfort from strain, poor posture, or injury. But for others, especially young adults, persistent back pain could be a sign of something more serious—a chronic inflammatory disease known as Ankylosing Spondylitis.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is a type of arthritis that primarily affects the spine, although other joints and organs can also be involved. It causes inflammation of the spinal joints (vertebrae), which can lead to severe, chronic pain and discomfort. In some advanced cases, this inflammation can lead to the fusion of vertebrae, resulting in a rigid spine.

The exact cause of AS is not fully understood, but genetics play a strong role. The HLA-B27 gene is found in the majority of people with the condition.

How is it Different from Common Back Pain?

Unlike mechanical back pain from injury or strain, AS usually begins gradually and is most noticeable in young adults under 40. The pain is typically worse in the morning or after periods of inactivity and improves with exercise. Unfortunately, many people with AS remain undiagnosed for years, mistaking their symptoms for common back issues.

Key signs that your back pain may be inflammatory:

•    Pain lasting more than 3 months

•    Morning stiffness lasting more than 30 minutes

•    Improvement with physical activity, not rest

•    Pain at night, especially in the second half

•    Family history of AS or autoimmune diseases
 
The Importance of Early Diagnosis

Early recognition and treatment of AS are crucial to prevent irreversible damage to the spine and maintain quality of life. Delayed diagnosis can lead to physical deformity, disability, and emotional distress.

How AS is Diagnosed?

Ankylosing Spondylitis (AS) is diagnosed through a combination of medical history (Duration of Back pain, Morning stiffness, family History), physical examination (Tenderness in the sacroiliac joints, Eye symptoms, Flexibility of the spine etc) blood tests (HLA-B27, Inflammatory markers like ESR, CRP), and imaging studies (MRI, X-Ray). Since no single test can confirm AS, a rheumatologist looks for a pattern of symptoms and evidence of inflammation.

Is AS Curable?

Currently, there’s no medication or procedure that can completely eliminate the disease, but it can be effectively managed with the right treatment and lifestyle changes. With early diagnosis and appropriate treatment, most people with AS can lead active, productive lives. The goal of treatment is to reduce pain, control inflammation, prevent joint damage, and maintain mobility.

Living with AS: Treatment and Support

There is no cure for AS, but a combination of medications, physical therapy, exercise, and patient education can help manage symptoms and slow disease progression. Anti-inflammatory drugs (NSAIDs), biologic therapies (like TNF inhibitors), and regular physiotherapy are commonly prescribed.

Whom Should You Consult?

A rheumatologist is a doctor specially trained in diagnosing and treating autoimmune and inflammatory conditions like Ankylosing Spondylitis. Because AS is often missed or misdiagnosed in early stages, consulting a rheumatologist can make all the difference. They have the expertise to recognize the subtle signs of inflammatory back pain, order appropriate tests (like MRI or genetic testing), and start treatment before joint damage occurs. Early referral can mean fewer complications, better pain control, and a healthier, more active life.

Raising awareness is the first step to combating AS. Let’s spread the word and support the millions silently suffering from this invisible disease.

This article has been contributed by Prof. Dr. Jyoti Ranjan Parida, Medical Director, Odisha arthritis & Rheumatology Center, Bhubaneswar