Treating Ankylosing Spondylitis

At least half of India’s population may not have heard of Ankylosing Spondylitis (AS), a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, affecting one in every 100 young adults in India.

According to GlobalData’s recent study, the diagnosed prevalence of AS in India is currently around 1.65 million and is estimated to grow at an annual growth rate of 2.95% to reach 2 million in 2028. Research studies show that this condition is 2-3 times more likely to affect men than women and is typically diagnosed in those younger than 40 years with symptoms first developing between 20 and 30 years of age.

One of the most under-diagnosed conditions in India mainly due to lack of awareness, AS is mostly mistaken for a “regular backache”. Overlapping symptoms between AS and backaches such as stiffness in the lower back, stiff joints or sudden shooting pain in the back or hips mainly lead to a delayed diagnosis that could ultimately result in fusion of the spine in abnormal positions.

It is important for one to understand this irritating and potentially serious condition. An early onset gives the disease more time to impact the body and can significantly affect the quality of life of a patient, besides its potential to cause a variety of major complications.

The possible list of complications of an inadequately treated AS patient consists of reduced spine mobility and flexibility, humped posture, joint damage or replacement, spine fracture, and increased risk of heart attacks.

Treatment for AS

It is important to visit a specialist, i.e., a rheumatologist in this case who can treat complex diseases that are often difficult to diagnose. With AS being a long-lasting condition, a rheumatologist is required to help find accurate treatments and strategies to manage the condition.

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. Biologics are designed to target specific proteins (TNF/IL-17A) that are involved in the inflammatory process. They not only help reduce the inflammatory pain but also reduce the risk of other comorbidities like eye inflammation, cardiovascular diseases, and even depression.

Challenges in treating AS

Unfortunately, over 50% of AS patients consult an orthopaedic or a physiotherapist before visiting the Rheumatologist. Owing to the lack of awareness, these doctors do not recommend them to see a specialist for this condition. Incorrect treatment even for 1-2 years, can lead to other medical conditions.

These problems in the country are further compounded by rheumatologists being in short supply in India. As per estimates, there are 209,000 patients with rheumatic complaints per rheumatologist in the country.

Approximately 69% of patients are being misdiagnosed in India and the right treatment is being prolonged, which can lead to irreversible structural damage to the spine leading to disability. If AS is not treated in time, the condition could lead to significant movement disability, spinal fractures, osteoporosis, and nerve damage. Hence, it is advisable to consult a rheumatologist quickly if there are any symptoms of AS.

(The writer is a rheumatologist)