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.
