Knock it while you still can...

By R. Khan
Tue, 07, 18

In a bid to spread awareness regarding Ankylosing Spondylitis (AS), Novartis held a press conference....

In a bid to spread awareness regarding Ankylosing Spondylitis (AS), Novartis held a press conference in Karachi in collaboration with the Pakistan Society of Rheumatology & Arthritis Care Foundation. You! takes a look...

Ankylosing Spondylitis (AS) is a serious disease, a form of arthritis that primarily affects the spine. It causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort. It is different from rheumatoid arthritis. Hip joint involvement is quite common and its prevalence in Pakistan could be between 0.5 to 1% of the population. However, this disease is on the rise as an increasing number of patients are surfacing. Moreover in our country, we are all aware of the fact that there is an acute shortage of qualified Rheumatologists in Pakistan and coping with an ever-increasing burden of arthritic patients is a great challenge.

Inactive lifestyle and the immense changes in the dietary pattern of the people in recent decades have made us vulnerable to all kinds of bone diseases, ranging from arthritis to osteoporosis. Recently, Novartis held a conference in Karachi to create awareness about the bone diseases among the younger generation. The conference focused on Ankylosing Spondylitis, a bone disease, at a local hotel in collaboration with the Pakistan Society of Rheumatology & Arthritis Care Foundation. Noted doctors and rheumatologists from all over the country discussed the causes, symptoms and treatments of AS.

The key speakers included Syed Mehfooz Alam, Executive board member of Pakistan Society of Rheumatology (PSR) and senior most Rheumatologist in Pakistan; Saliha Ishaq from Aga Khan University Hospital; Tahira Peveen, Head of department, Liaquat National Hospital; Shafaq Abbass, Executive board, Arthritis Care Foundation and Shehla Naseem, Chief Scientific Officer Novartis Pakistan. Also, a large number of healthcare and social organisations were in attendance including Aman Foundation, Sehat Kahani,,, Oladoc and Findmydoctor.

The speakers highlighted the impact of the disease on the lives of patient and discussed ways and means on how to prevent it. Renowned doctors shed light on the necessary information to the general public in order to establish preventive measures. One of the major aspects about the disease discussed was how prevention is better than cure in case of AS; because once this disease is inflicted, it cannot be cured for once. They also said, “AS is a kind of arthritis that primarily affects the spine. It can cause the spine to fuse in a fixed, immobile position, sometimes creating a forward-stooped posture. AS is most common among young population - usually the 20-40 year bracket contrary to the perception that arthritis takes place during senility.”


There are still studies required for clarifying the triggers of this disease. Some of them are clues to the relative role of genetics, environmental factors and geographical settings. For example people living in extreme cold conditions are also prone to it, but further studies are required to establish the exact causes. Either way, AS often leads to severe disability, hence an early diagnosis and prompt treatment is required for better disease control and quality of life.

The most striking feature of the disease is that despite being a very common it takes a period of 8-10 years for the onset of the symptoms to be diagnosed in patients. If the diagnosis is delayed and not carried out on time, it can lead to irreversible damage to the spine thereby restricting mobility on permanent grounds. This condition is also known as ‘Bamboo Spine’ and is more common in men than women.

Identifying the symptoms can be tricky as X-rays do not help during early diagnosis because inflammation is not visible on X-ray until bone damage starts. MRI and ultrasound of the pelvis are usual confirmatory tests carried out by rheumatologists performing the treatment. The main features of AS include prolonged backache for several months with the pain getting worst at rest and improving with mobility, exercise, morning stiffness, swollen joints and pain in buttocks shifting from one side to another.

It can also affect other areas of the body including lungs, bowel and eyes. Uveitis, IBS, heart problems, osteoporosis, spinal fractures and psoriasis are associated complications of AS.


The goal of treatment is to relieve your pain and stiffness, and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints. Here are some of the ways to treat AS:

Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) - such as naproxen (Naprosyn) and indomethacin (Indocin) - are commonly use to treat AS. They can relieve your inflammation, pain and stiffness. However, these medications might cause gastrointestinal bleeding. If there is no response to NSAIDs after weeks, it is better to change the it. Some patients continue with it and do not inform their doctors for months. These NSAIDs do slow down the progression of the disease on X-Ray.

Therapy: Patient education, physical therapy, exercise, rehabilitation programmes are all very effective and useful. There are patients who have formed their own help groups overseas and here in Pakistan. Such platforms should be established for patients to come together and learn from each other’s experiences to cope with their condition.

Diet and exercise: It is the single most important thing a person with AS can do. A range of motion and stretching exercises can help maintain flexibility in the joints and preserve good posture. Proper sleep and walking positions and abdominal and back exercises can help maintain your upright posture. While painkillers will help in reducing pain, improving your diet and exercise can make a noticeable difference.

Awareness: The speakers suggested that a good balanced diet and exercise are particularly important during childhood and adolescence so this disease can be prevented. However, when the problem may have already occurred, treatment will be of prime importance.