When back pain turns serious: Doctors explain Ankylosing spondylitis

Affecting mostly young adults, ankylosing spondylitis is an autoimmune condition that requires lifelong management and early medical intervention

Back pain is common and most people blame long hours at a desk or a minor strain, but for some young adults the discomfort is a sign of a chronic inflammatory disease that can gradually stiffen the spine. Ankylosing spondylitis is not just another ache, and early recognition can make the difference between a flexible future and permanent damage.

 

What is Ankylosing spondylitis

 

“Ankylosing spondylitis is an inflammatory arthritis of the axial skeleton, means of the spine,” says Dr Manoj Sharma, Senior Orthopaedic and Spine Surgeon, Fortis Hospital, Delhi. He explains that unlike rheumatoid arthritis which affects the small joints of the hands and feet, ankylosing spondylitis primarily involves the spine and can extend to the hips and knees.

 

 

He adds, “It is an arthritis which is very debilitating and because it causes severe pain, stiffness and ultimately fusion of the spine. The spine can turn into a single bone.” Doctors often refer to this fused appearance as a bamboo spine because the 33 vertebrae can merge into one rigid column.

 

Dr Vinit Banga, Director-Neurology, Fortis Hospital, Faridabad, notes that this condition differs from mechanical back pain because it is driven by inflammation. The pain is often worse in the morning or after rest and it improves with movement, whereas typical back strain behaves in the opposite way.

 

Why it is often missed

 

Ankylosing spondylitis is frequently diagnosed late because early symptoms resemble common back pain and X-rays may appear normal in the beginning. However there are red flags that should not be ignored:

 

• Persistent back pain before the age of 45
• Morning stiffness lasting more than 30 minutes
• Pain that improves with exercise but not with rest
• Alternating buttock pain
• Episodes of painful red eye

 

Dr Sharma points out that the disease commonly affects young adults between 20 and 30 years of age and it is more common in men with a three to one male to female ratio. He emphasises that it is not caused by trauma or infection, and it often has a hereditary component.

 

“There is a special gene in it called HLA-B27.We test for the gene in the blood, and if it is positive then the patient is more likely to develop ankylosing spondylitis,” he says, although experts clarify that not everyone with this gene will develop the disease.

 

Beyond the Spine

 

Although ankylosing spondylitis mainly targets the spine and sacroiliac joints, it can affect other organs as well. Patients may develop uveitis which causes a painful red eye, and some may experience gut inflammation. In rare cases, there can be involvement of the heart valves or reduced chest expansion which affects lung capacity.

 

This broader impact shows that ankylosing spondylitis is an autoimmune inflammatory disease and not just a back problem.

 

Treatment: From exercise to biologics

 

While there is no permanent cure for ankylosing spondylitis, modern therapies aim to control inflammation, prevent joint damage and maintain mobility throughout life. Dr Sharma stresses the importance of non-drug measures alongside medicines.

 

“The most important thing is heat which will relieve the muscle spasm and then exercises, morning walks and moving all the joints especially of spine and hip to its full range so that they do not get stiff,” he says. Good posture and physiotherapy are equally crucial.

 

Recommended medications may include:

 

• Anti-inflammatory drugs and pain relief
• Muscle relaxants
• Disease modifying drugs such as methotrexate
• Biologics including TNF inhibitors and anti-IL-17 inhibitors
• Newer oral JAK inhibitors

 

Dr Banga explains that modern biologic medications are effective in controlling pain and stiffness and in slowing joint damage, especially when started early. However biologics are expensive because they are lab engineered proteins that require strict manufacturing and storage standards. In India a single injection can cost from ₹6,000 to over ₹25,000 and some patients may need them twice a month, while insurance coverage remains limited.

 

Dr Neha Pandita, Senior Consultant-Neurologist, Fortis Noida, highlights that early detection and strict adherence to medication can help prevent spinal fusion and organ damage. She adds that avoiding smoking, maintaining a healthy weight and managing stress are equally important so that individuals can lead near normal lives.

 

When surgery is needed

 

While spine surgery has a limited role, hip replacement may be necessary if the hip joints become fused and walking becomes impossible. In rare cases where the neck is fixed in a severely bent position, corrective surgery may be performed to restore a a normal line of sight..

 

Diet and daily living

 

An anti-inflammatory diet may support medical treatment and help manage symptoms. Experts suggest:

 

• Eating fruits, vegetables and whole grains
• Including fatty fish, nuts and olive oil
• Limiting processed foods, refined sugar and fried items
• Reducing excessive red meat

A balanced diet also helps maintain a healthy weight which reduces stress on the joints.

 

Living with Ankylosing spondylitis

 

Ankylosing spondylitis can feel isolating, especially because it often affects people in their most active and productive years. However, many individuals continue to pursue demanding careers and creative passions despite the challenges.

 

Dan Reynolds, lead singer of the band Imagine Dragons, has spoken openly about living with the condition and managing pain while performing on stage, showing that a diagnosis does not have to define one’s limits.

 

Doctors also witness the emotional impact of delayed diagnosis. One young corporate professional recalls feeling frustrated when years of chronic back pain were dismissed as stress-related. Another patient shares that early access to targeted therapy helped him prevent spinal deformity and maintain an active lifestyle.

 

Experts emphasise that persistent back pain should never be ignored. With timely diagnosis, consistent exercise and access to modern treatments, many people with ankylosing spondylitis are able to remain mobile and independent. With the right support, they can continue to build fulfilling professional and personal lives.      

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This report is for informational purposes only and is not a substitute for professional medical advice.