Dr. Abhrajit Ray

MD (Cal), MRCP (UK), MRCP (London)
Consultant Physician & Rheumatologist
Radiant Medical Centre, Kolkata
Visiting Consultant Physician & Rheumatologist
Fortis, Bellevue, Woodlands Hospital, Kolkata


Low back pain with early morning stiffness persisting for more than 3 months in young men adolescent or buttock pain can herald the onset of spondyloarthritis. HLAB27 positive in about 90% of AS, skin lesion like Psoriasis (PsA); reactive arthritis following urinary or bowel disorder enteropathic arthritis & juvenile SPA (age < 16 years) is a part of the spectrum of disease. A healthy life style with 1 hour of exercise daily, absence of smoking along with judicious use of NSAIDS/DMARDS & Anti TNF agent will often control the disease & prevent the need for surgery especially in early phase.

The most common is ankylosing spondylitis, which affects mainly the spine. Others include:

1) axial spondyloarthritis, which affects mainly the spine and pelvic joints;
2) peripheral spondyloarthritis, affecting mostly the arms and legs;
3) reactive arthritis (formerly known as Reiter's syndrome);
4) psoriatic arthritis; and
5) enteropathic arthritis/spondylitis associated with inflammatory bowel diseases (ulcerative colitis and Crohn's disease).

What causes Ankylosing Spondylitis?

Ankylosing spondylitis is hereditary. Many genes can cause it. Up to 30 of these genes have been found. The major gene that causes this disease is HLA-B27. Almost all white people with ankylosing spondylitis are carriers of HLA-B27.
Enteropathic arthritis is a form of chronic, inflammatory arthritis. The two most common types are ulcerative colitis and Crohn's disease. The cause of enteropathic arthritis is unclear. It may be due to bacteria that enter the bowel when inflammation damages it. People with HLA-B27 are more likely to have this form of arthritis than those without the gene.
Discussions of the causes and risk factors for other members of the spondyloarthritis family appear in their own fact sheets.

How is Ankylosing Spondylitis diagnosed?

Ankylosing spondylitis tends to start in the teens and 20s and strikes males two to three times more often than females. Family members of affected people are at higher risk, depending partly on whether they inherited the HLA-B27 gene.
There is an uneven ethnic distribution of ankylosing spondylitis. The highest frequency appears in the far north in cultures such as Alaskan and Siberian Eskimos and Scandinavian Lapps (also called Samis), who have a higher frequency of HLA-B27. It also occurs more often in certain Native American tribes in the western U.S. and Canada. African Americans are affected less often than other races.
Based on data from the National Health and Nutrition Examination Survey (NHANES), the frequency of ankylosing spondylitis in the U.S., is 0.5 percent. The frequency for axial spondyloarthritis is 0.14 percent.