Ankylosing Spondylitis: Causes, symptoms, importance of early diagnosis, treatment
To promote awareness of ankylosing spondylitis and mobilise supporters to take action, World Ankylosing Spondylitis Day is observed internationally on the first Saturday of every May, except if the Saturday is May 1st and this year the day will be marked on May 7, 2022. A type of inflammatory arthritis that predominantly affects the spine and sacroiliac joints (where the spine connects to the pelvis), ankylosing spondylitis causes lower back, hip and pelvic pain.
Reports suggest that in India, around 1.65 million people are currently diagnosed with the condition, that is estimated to grow at an annual growth rate of 2.95% as per Global data’s recent study and with the lack of understanding around this disease, 69% patients are either misdiagnosed or remain unaware, which further worsens their condition.
In an interview with HT Lifestyle, Dr PD Rath, Consultant Rheumatologist, Director and Head of Department Rheumatology at New Delhi's Max Hospital, shared, “There isn’t a definite reason behind AS’ origination, however it is usually believed to be genetic. A gene called HLA B27 is found in one’s body which is triggered by the environmental conditions and lifestyle patterns that can lead up to the disease. It is essential to understand that simply the presence of this gene does not mean that one would suffer from AS.”
Dr Ved Chaturvedi, Vice-President, Asia Pacific League of Associations for Rheumatology (APLAR), revealed, “Due to its auto-inflammatory nature, Ankylosing Spondylitis is seen to be aggravated when inactivity in patients increases. Patients suffering from the condition should be mindful of their lifestyle and focus on inculcating a positive and active lifestyle. Inflammatory low backache and lower limb arthritis are the early symptoms of the diseases, therefore, an early effort must be put towards the remittance of the disease; if one notices these symptoms.”
According to Dr PD Rath, “In the condition of Ankylosing Spondylitis, the pain and stiffness in one’s back is worse in the morning and night but keeps improving with the progression of the day because of gentle activity.” Dr Nilesh Nolkha, Consultant Rheumatologist and Clinical Immunologist, Wockhardt Hospitals Ltd., Mumbai, said, “Experiencing severe pain in the low back and buttocks that makes sleeping at night a discomfort is one of the first key triggers of Ankylosing Spondylitis (AS). Any kind of pain that is instigated through inactivity and resting, before 45 years of age can be termed as the pain of AS.”
Importance of early diagnosis:
Highlighting that on an average, patients that are unaware of the condition usually end up delaying their diagnosis by 5-6 years which is a significant amount of time, Dr Nilesh Nolkha pointed out, “Crucial treatment time is lost, as these patients consult with a physiotherapist, orthopedic, or sometimes a neurosurgeon, thinking of AS as a nerve related problem. Additionally, the number of Rheumatologists in India is far from ideal which prolongs the treatment even further. Finding a good general practitioner, or teleconsultation have proven to be significant substitutes.”
He added, “A lot of AS patients also report mental health issues since the condition severely affects their everyday lifestyle. In such situations, one can get involved with support groups such as Antardhwani that have a significant presence in India. These support groups spread awareness about the disease, can help understand it, and carry out regular programs.”
Dr Ved Chaturvedi stressed, “It is key to consult with a Rheumatologist for accurate treatment to provide any misdiagnosis or delayed diagnosis of the disease, which is set to worsen the condition. These patients are sure to benefit from Biologics that their Rheumatologist would prescribe along with creating a healthier lifestyle. Advance treatments such as Biologics have transformed the face of this disease, my patients have personally seen a great deal of improvement with the intake of this drug.”
Echoing the same, Dr PD Rath said, “Patients are advised to stay active and keep their joints and muscles moving throughout the day because it helps reduce inflammation. If someone is suffering from this kind of a pain, it is important for them to consult with a Rheumatologist, because such pain could initiate the condition of AS.”
He advised, “Certain lifestyle changes also help build a healthier pattern to live with AS, such as monitoring the C-reactive protein (a marker of systematic inflammation) from time to time, regular exercises, a healthy diet rich in Omega 3, flax seeds, fruits, and green vegetables. In addition to lifestyle changes, along with medications help control the progression of the condition efficiently.”
Dr Nilesh Nolkha too asserted that it is important for patients suffering from this lifestyle condition to practice regular workouts and consult a Rheumatologist to find the best fit treatment plan. He said, “There are advanced treatment options available such as Biologics that help slow down the structural damage progression caused by AS, preventing bone fusion and in many cases preventing new bone formation.”
It’s important to focus on how one can build a routine to find a way around deficiencies when it comes to health issues - follow through with a strict and healthy diet, and self-monitor your progress to keep your pains in check. Make sure that you consult your Rheumatologist regularly because ankylosing spondylitis is a disease that requires timely intervention, accurate treatment and a carefully managed lifestyle.