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This is a type of inflammatory arthritis that affects the spine. Pain, stiffness, reduction in movement and rigidity of the spine are the major symptoms. Pain usually starts at the low back with stiffness, later affecting the whole spine. Patient may also feel pain in the shoulders, hips, buttocks, heels and ribs. In chronic stage, the small joints in the spine will fuse together and reach a stage like bamboo spine. Morning stiffness of the whole back is very common. Due to the hardening of the ligaments and fusing of the vertebrae, person will slouch forward. Men are affected more than women and the specific reason is unknown. Genetic factor plays a key role. Those who have a gene called HLAB27 is at a greater risk of developing this disease.

This condition can be considered as a chronic stage of vataraktha. Here vata, raktha and kapha become aggravated and the disease is manifested majorly at the hip, spine and its related structures. Treatment starts with appropriate combination of internal medicines to reduce the inflammation. Therapies like application of medicated pastes (lepa) and pouring of herbal decoctions (dhara) will reduce the pain and stiffness. Therapies like application of poultice made of herbal leaves (ela kizhi), pouring of herbal oil all over the body (pizhichil), purgation with appropriate medicine and enema (vasti) with herbal decoction and medicated oil are the procedures usually done to manage the condition and to prevent further deterioration. Continuing with internal medications as a combination with practise of yoga, modifications in diet and lifestyle and periodical eliminative therapies will help in effective management.