Non- radiographic spondyloarthropathy (nr-SpA) and Ankylosing spondylitis (AS) are subtypes of axial spondyloarthritis (axSpA). patients with AS exhibit radiologic abnormalities consistent with sacroilitis, with no evidence on plain radiograph. Instead, in nr-axSpA, the diagnosis is supported by evidence of active inflammation of sacro-iliac (SI) joint on magnetic resonance imaging (MRI) and/or a combination of other findings. Clinical importance of considering the two conditions differently is to understand the critical question whether inflammation and new tissue formation in SpA are linked or uncoupled processes. This case was treated considering both the pathologies as the stages of same disease, hypothesized as active inflammation at the joint (due to mechanical stress and/or degeneration) occurring primarily. This along with environmental factors trigger the genetic determinant which in turn activate the immune system and polymorphisms in cytokines and cytokine processing molecules that lead to either more severe inflammation or delayed clearance of inflammation. Auto immune responses induce abnormal surrogate tissue formation at the stress site lead to ankylosis of spine. Treatment done considering the primary stage as sandhivata which developed as its complicated form aamavata showed substantial relief in pain and functional ability of the patient.
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