Ankylosing Spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. Chronic inflammation in these areas causes pain and stiffness in and around the spine. Over time, chronic spinal inflammation can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis leads to loss of mobility of the spine and the condition known as bamboo spine. Prevalence of Ankylosing spondylitis in India is 0.1% to 0.3% as per surveys conducted by Bone and Joint Decade India from 2014 to 2020.

Ankylosing spondylitis is also a systemic disease which can affect other tissues, throughout the body. Accordingly, it can cause inflammation or injury to other joints away from the spine, as well as to other organs, such as the eyes, heart, lungs, and kidneys. Ankylosing spondylitis shares many features with several other arthritis conditions such as psoriatic arthritis, reactive arthritis (formerly called Reiter’s disease), and arthritis associated with Crohn’s disease and ulcerative colitis. Each of these arthritic conditions can cause disease and inflammation in the spine, other joints, eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these conditions are collectively referred to as “Spondylo arthropathies”.  

Ankylosing spondylitis is considered one of the many rheumatic diseases because it can cause symptoms involving muscles and joints.Men are affected more than women by a ratio about of 3:1. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. When it affects children, it is referred to as Juvenile ankylosing spondylitis.

There is a need to search satisfactory treatment available in other medical system. A treatment of Ankylosing spondylitis can be as ofAyurvedic management of Amavata . The manifestation of Vata Vyadhi (different disease due to Vata dosha) is prominent in fully established Ankylosing spondylitis. In Ankylosing spondylitis; the entheseal fibrocartilage is the major target of the immune system, and there may be destructive synovitis. The myxoid subchondral bone marrow is mainly affected. There is the destruction of nearby articular tissues or joint tissues as disease progresses. The new and original cartilages are replaced by bone through fusion. This causes fusion of the joint bones that causes stiffness and immobility. This fusion leads to bamboo spine formation, a hallmark of Ankylosing spondylitis. Ayurveda interprets these changes as vitiated Vata dosha that affect Asthi dhathu (bones). It can also be treated on the line of Ayurvedic management of Asthimajja gata vata (∼Vatadisorder involving bone and bone marrow).  

The symptoms of Ankylosing spondylitis are related to inflammation of the spine, joints, and other organs. Fatigue is a common symptom associated with active inflammation. Inflammation of the spine causes pain and stiffness in the low back, upper buttock area, neck, and the remainder of the spine. The onset of pain and stiffness is usually gradual and progressively worsens with loss of range of motion noticeable over months. Occasionally, the onset is rapid and intense.In the early stages of Ankylosing spondylitis, there may be mild fever, loss of appetite and general discomfort. Lumbar pain (low back pain) and buttock pain are common manifestations of active inflammation in the lumbar spine and sacroiliac joints. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity. Motion, heat, and a warm shower often eases pain and stiffness in the morning.Those who have chronic, severe inflammation of the spine can develop a complete bony fusion of the spine (ankylosis). Once fused, the pain in the spine disappears, but the affected individual has a complete loss of spine mobility. These fused spines are particularly brittle and vulnerable to breakage (fracture) when involved in trauma such as motor-vehicle accidents. A sudden onset of pain and mobility in the spinal area of these patients can indicate bone breakage. The lower neck (cervical spine) is the most common area for such fractures.

Chronic spondylitis and ankylosis cause forward curvature of the upper torso (thoracic spine), which limits breathing capacity. Spondylitis can also affect the areas where ribs attach to the upper spine, further limiting lung capacity. Ankylosing spondylitis can cause inflammation and scarring of the lungs, causing coughing and shortness of breath, especially with exercise and infections. Therefore, breathing difficulty can be a serious complication of Ankylosing spondylitis.People with Ankylosing spondylitis can also have arthritis in joints other than the spine. This feature occurs more commonly in women. Patients may notice pain, stiffness, heat, swelling, warmth, and/or redness in joints such as the hips, knees, and ankles. Occasionally, the small joints of the toes can become inflamed or “sausage” shaped. Inflammation can occur in the cartilage around the breastbone (costochondritis) as well as in the tendons where the muscles attach to the bone (tendinitis) and in ligament attachments to bone. Some people with this disease develop Achilles tendinitis, causing pain and stiffness in the back of the heel, especially when pushing off with the foot while walking upstairs. Inflammation of the tissues of the bottom of the foot, plantar fasciitis, occurs more frequently in people with Ankylosing spondylitis.Advanced spondylitis can lead to deposits of protein material called amyloid into the kidneys and result in kidney failure. Progressive kidney disease can lead to chronic fatigue and nausea and can require removal of accumulated waste products in the blood by a filtering machine (dialysis). 

The symptoms of continuous joints pain, kyphosis, scoliosis, limping, fatigue, weight loss, and severely disturbed sleep can be compared with symptoms of Asthimajja gata vata as Asthibheda (stabbing pains in bones), Parva bheda (pain in joints of fingers) Sandhishoola (pain in joints), Mamsa kshaya (depletion of muscular tissue) and Bala kshaya (decreased vitality and strength), Aswapana (sleeplessness) and Satataruka (continuous pain) are the manifestation of Asthimajja gata vata. Adhyasthi (Fusion of syndesmophytes) is the manifestation of Asthipradoshavikara (Diseases of bones). Vinamata (bending of the body as kyphosis) is the manifestation of Majjavritavata.

There is no direct test to diagnose Ankylosing spondylitis. A clinical examination, MRI and X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis, and a simple genetic marker blood test are the major diagnostic tools. A drawback of X-ray diagnosis is the signs and symptoms of Ankylosing spondylitis have usually been established as long as 8–10 years prior to X-ray-evident changes occurring on a plain film X-ray, which means a delay of as long as 10 years before adequate therapies can be introduced. Options for earlier diagnosis are tomography and magnetic resonance imaging of the sacroiliac joints, but the reliability of these tests is still unclear.During acute inflammatory periods, Ankylosing spondylitis patients will sometimes show an increase in the blood concentration of C-reactive protein (CRP) and an increase in the erythrocyte sedimentation rate (ESR), but there are many with AS whose CRP and ESR rates do not increase, so normal CRP and ESR results do not always correspond with the amount of inflammation a person actually has. Sometimes people with AS have normal level results, yet are experiencing a significant amount of inflammation in their bodies.Variations of the HLA-B gene increase the risk of developing Ankylosing spondylitis, although it is not a diagnostic test. Those with the HLA-B27 variant are at a higher risk than the general population of developing the disorder. HLA-B27, demonstrated in a blood test, can occasionally help with diagnosis, but in itself is not diagnostic of Ankylosing spondylitis in a person with back pain. Over 95% of people that have been diagnosed with ankylosing spondylitis are HLA-B27 positive, although this ratio varies from population to population.

There is no cure for AS, although treatments and medications can reduce symptoms and pain according to the modern science.The major types of medications used to treat ankylosing spondylitis are pain-relievers and drugs aimed at stopping or slowing the progression of the disease. All of these have potentially serious side effects. Pain-relieving drugs come in two major classes:The mainstay of therapy in all seronegative spondyloarthropathies are anti-inflammatory drugs, which include NSAIDs such as ibuprofen, phenylbutazone, diclofenac, indomethacin, naproxen and COX-2 inhibitors, which reduce inflammation and pain. Indomethacin is a drug of choice.

 
This combined Ayurvedic treatment of above mentioned oral Ayurvedic drugs and Panchakarma procedures are helpful in treating the patient of Ankylosing Spondylitis.
But the treatment of the patient should only under the supervision of a Registered Ayurveda Practioner.