Comprehensive management of ankylosing spondylitis health risk: Disease-modifying drugs and exercise approaches in the Indian population – A scoping review

Abstract

Ankylosing spondylitis (AS) is a long-standing inflammatory condition of the axial skeleton marked by progressive structural changes, resulting in pain, reduced spinal mobility, functional limitation, and increased risk of extra-articular manifestations. Early and sustained intervention is essential to prevent irreversible structural damage and health risk of the individual with Ankylosing Spondylities. The present review is undertaken to comprehensively map the existing body of evidence on pharmacological and exercise-based management of AS, with particular emphasis on applicability within the Indian healthcare context. This study employed the Arksey and O’Malley framework to conduct the scoping review, with reporting guided by the PRISMA-ScR checklist. 70 full texted article literature was identified from databases including PubMed, Scopus, and Google Scholar, focusing on studies published in English that examined disease-modifying drugs and exercise interventions in AS. Evidence indicates that NSAIDs remain first-line therapy for symptom control, while biologic agents, particularly TNF and IL-17 inhibitors, significantly reduce disease activity and enhance overall well-being. Exercise approaches, including aerobic training, strengthening, and flexibility exercises, demonstrate consistent benefits in maintaining spinal mobility. Indian studies highlight the additional role of culturally relevant practices such as yoga. However, barriers such as cost, limited access to biologics, and adherence challenges persist. A combined approach integrating pharmacological therapy and structured exercise programs offers optimal outcomes in AS management. In India, addressing accessibility and promoting culturally adaptable interventions are essential for improving patient care.