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Ankylosing Spondylitis: Symptoms, Diagnosis, and Treatment in Dhaka, Bangladesh

Ankylosing spondylitis is a long-term inflammatory disease that mainly affects the spine and the sacroiliac joints, which connect the lower spine to the pelvis. It can also involve the hips, shoulders, ribs, heels, and other areas where tendons attach to bone. The most important thing to understand is that this is not ordinary back strain. It is an inflammatory condition that can gradually reduce flexibility if it is not recognized early.

In Bangladesh, I often see patients spend months or even years being treated for “regular back pain” before the pattern of inflammatory pain becomes clear. That delay matters. The sooner the diagnosis is considered, the sooner the patient can begin proper treatment, movement advice, and follow-up planning.

What Ankylosing Spondylitis Means

Ankylosing spondylitis belongs to a group of inflammatory diseases called spondyloarthritis. It usually begins in young adults, often before the age of 45. The pain commonly affects the lower back, buttocks, and hips, and it tends to behave differently from mechanical pain caused by lifting, sitting awkwardly, or muscle strain.

When I evaluate patients with back and hip pain, I pay close attention to the pattern of symptoms. Inflammatory pain is often worse after rest, more noticeable in the early morning or during the night, and easier after movement. That is a very different story from simple overuse pain.

Common Symptoms

The symptoms can come and go, and they may build slowly over time. Common features include:

persistent low back pain
buttock pain, sometimes on alternating sides
morning stiffness that lasts a long time
pain that improves somewhat with activity
night pain that wakes the patient from sleep
fatigue or low energy
stiffness in the hips, shoulders, or chest wall
heel pain or pain where tendons attach to the bone

Some people also develop eye inflammation, usually with redness, pain, and light sensitivity. Others may notice joint pain beyond the spine. In more advanced cases, spinal movement becomes limited and posture may change.

Why It Is Often Missed

The condition usually develops slowly. Many patients continue daily work, study, and family responsibilities while assuming the pain is temporary. In Bangladesh, that often means people try painkillers, massage, rest, or repeated home treatment before they seek the right evaluation.

Another reason it is missed is that symptoms may improve briefly with common anti-inflammatory medicine. Temporary relief does not rule out ankylosing spondylitis. It only means the inflammation may be responding for the moment.

Causes and Risk Factors

The exact cause is not fully known. Genes and the immune system both appear to play a role. A family history of ankylosing spondylitis or related inflammatory diseases can increase the likelihood of developing it.

People with psoriasis, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, or a family history of similar conditions may have a higher risk. Smoking can worsen spinal inflammation and long-term outcomes, so it is an important risk factor to address.

How Doctors Diagnose It

There is no single test that confirms or excludes ankylosing spondylitis. Diagnosis depends on a combination of history, examination, blood tests, and imaging.

History and Examination

I want to know:

when the pain started
whether stiffness is worse after rest
whether movement makes the pain better
whether the pain wakes the patient at night
whether there is hip pain, heel pain, or eye inflammation
whether there is a family history of similar illness

The physical examination usually includes posture, spinal movement, chest expansion, hip motion, and tenderness over the sacroiliac joints.

Tests That May Help

Blood tests may support the diagnosis, but they do not prove it by themselves. HLA-B27 may be helpful in the right clinical setting, yet a person can have ankylosing spondylitis without that marker. X-rays can show later changes, while MRI may detect earlier inflammation before visible damage appears on X-ray.

Treatment Goals

There is no permanent cure, but there are effective ways to control symptoms and protect function. The goals of treatment are to:

reduce pain and stiffness
preserve mobility and posture
slow progression of inflammation and damage
help the patient stay active and independent

Rheumatology usually leads the long-term medical treatment. Orthopedic care becomes important when hip involvement, structural deformity, or fracture risk needs additional evaluation.

Treatment Options

Exercise and Physiotherapy

Movement is a core part of treatment. This is not a condition where prolonged rest helps. In fact, too much inactivity usually makes stiffness worse. Regular stretching, posture work, spinal mobility exercises, and breathing exercises are often helpful.

Many patients do better when exercise becomes part of the daily routine rather than something done only after pain becomes severe.

Medicines

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Anti-inflammatory medicine may be used to help control pain and stiffness. Some patients need stronger specialist-directed treatment, including biologic medicine or other immune-targeted therapy when the disease is active or not well controlled.

Surgery

Surgery is not the usual treatment for ankylosing spondylitis, but it may be needed in selected cases, especially if there is significant hip damage, severe structural problem, or a fracture in a stiff spine.

Daily Life Advice for Patients in Bangladesh

Practical habits matter. In Dhaka and across Bangladesh, many patients sit for long hours at work, travel on uncomfortable roads, sleep on poor bedding, or delay specialist review because they assume the pain is only muscular.

What usually helps is a steady plan:

keep moving within safe limits
avoid long periods of bed rest
pay attention to posture
follow the prescribed medicine plan carefully
stop smoking if you smoke
return for review if stiffness or pain is increasing

It is also important to remember that anxiety and sleep disruption can make the pain feel worse. Patients should not ignore the emotional burden of a long-term condition.

When Orthopedic Review Matters

Although ankylosing spondylitis is primarily an inflammatory rheumatic disease, orthopedic assessment becomes important when the spine or hips are structurally affected. I pay particular attention if a patient has:

worsening hip pain or hip stiffness
marked loss of spinal movement
posture changes
a history of minor trauma with severe pain
difficulty walking because of joint involvement

The reason for caution is simple: a stiff spine can be more vulnerable to injury, and hip disease can affect walking and independence. Those issues deserve timely assessment.

When to Seek Urgent Medical Care

Some symptoms should not wait for a routine appointment. Urgent evaluation is needed if a patient has:

sudden weakness, numbness, or trouble walking
loss of bladder or bowel control
severe pain after a fall or other trauma
a red, painful eye with light sensitivity
fever with severe spinal pain
rapidly worsening chest pain or breathing difficulty

These symptoms may point to eye inflammation, spinal injury, nerve involvement, infection, or another serious problem.

Why Rheumatology and Orthopedics Often Work Together

Ankylosing spondylitis is not only a bone or joint problem. It often needs rheumatology guidance for inflammation control and orthopedic input when pain, posture, mobility, hip damage, or mechanical complications become significant. I usually explain that coordinated care is often the safest approach for Bangladeshi patients with long-standing inflammatory back pain.

Why co-management matters in ankylosing spondylitis

Ankylosing spondylitis is not only a mechanical back pain problem. When inflammatory back pain is suspected, long-term care often benefits from both orthopedic and rheumatology input so that stiffness, posture, function, and medication planning are addressed together.
That shared approach becomes particularly important when symptoms begin early, morning stiffness is prolonged, or other joints are involved.

References

Why Rheumatology Co-Management May Be Important

Ankylosing spondylitis is not only a mechanical back pain problem. When morning stiffness, alternating buttock pain, eye inflammation, prolonged inflammatory symptoms, or restriction of chest expansion are present, I often advise coordinated care with a rheumatologist because long-term control may involve more than orthopedic treatment alone.

For patients in Bangladesh, that shared approach helps distinguish inflammatory disease from routine back strain and supports a more complete plan for pain control, posture, mobility, and follow-up.

Why co-management is important in ankylosing spondylitis

Although patients may first come with back pain, ankylosing spondylitis often needs coordinated care rather than isolated pain treatment. I usually explain that inflammatory back pain, prolonged morning stiffness, and reduced spinal mobility can require rheumatology input along with rehabilitation and monitoring of function.

For Bangladeshi patients, early recognition matters because inflammatory back pain is often mistaken for ordinary mechanical strain for too long. If the symptoms are chronic, worse after rest, and improve somewhat with movement, a more specific evaluation is worthwhile.

About Dr. Md. Iftekharul Alam

Dr. Md. Iftekharul Alam, MBBS (Dhaka), MS (Nitore/Pangu Hospital), F.A.C.S (USA), F.I.J.R (Kolkata), F.A.S.M (Osaka, Japan), is an Orthopedic Surgery specialist focused on arthroscopy and arthroplasty. He is an Assistant Professor at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR). His clinical focus includes knee and shoulder arthroscopy, hip and knee replacement, sports injuries, ACL and PCL injuries, trauma, and joint conditions.

FAQs BY PATIENTS

Can ankylosing spondylitis improve without surgery?

Some cases of ankylosing spondylitis improve with careful non-surgical treatment such as rest, physiotherapy, activity modification, splinting, medicine, or guided rehabilitation. Surgery is usually considered only when symptoms remain significant, the structure is clearly damaged, or function is not returning as expected.

What symptoms of ankylosing spondylitis mean I should see a specialist?

I encourage patients to seek evaluation if pain, weakness, swelling, locking, instability, numbness, or loss of movement is interfering with daily life. The earlier the diagnosis is clarified, the easier it often is to choose the right treatment pathway.

Do I need an X-ray, MRI, or other tests for ankylosing spondylitis?

Not every patient needs advanced imaging immediately. The best test depends on the history, the examination, and whether the concern is bone, ligament, tendon, cartilage, nerve, or inflammatory disease.

How is ankylosing spondylitis usually treated, and when is surgery considered?

Treatment usually starts with the least invasive option that fits the diagnosis, such as medicine, physiotherapy, bracing, injection, or guided rehabilitation. Surgery is more likely when there is a significant tear, instability, deformity, nerve compression, or failure of appropriate conservative care.

What warning signs with ankylosing spondylitis should make me seek urgent care?

Urgent review is important for severe swelling, a hot or red joint with fever, inability to bear weight, sudden major weakness, numbness, circulation changes, or pain after major trauma. These findings can suggest infection, fracture, dislocation, or another problem that should not be delayed.