Ankylosing spondylitis has afflicted people for centuries. St Banus suffered from it in the 4th century AD, and Rameses II in the 12th century BC — although his stiff, painful, stooped back did not prevent Rameses from leaving his mark on both the landscape and the population of Ancient Egypt. The great pharaoh built more temples than any other Egyptian ruler and had between 90 and 160 children. His son Merneptah and an earlier pharaoh, Amenhotep II, are also thought to have had ankylosing spondylitis.

Hippocrates, who lived more than a millennium after those pharaohs, recorded the clinical differences between what we now call ankylosing spondylitis and rheumatoid arthritis. The arthritic features of ankylosing spondylitis were first described in medical literature in 1559, and its association with iritis and uveitis — inflammation in the eye — was noted in the 1700s, but most of its other features were not recognised until the 19th century.

It is not surprising that ankylosing spondylitis attacked more than one of the pharaoh’s family, as it is associated with a group of diseases in which the patient is HLA B27 positive. HLA B27 is one of the HLA antigens — genetic cell markers that were first recognised on human white blood cells but are found on the cells of all human tissue. If a parent has ankylosing spondylitis there is a 50 per cent chance that the gene B27 will be passed on, but only half of their offspring will show evidence of clinical disease.

The first symptoms of ankylosing spondylitis, which attacks about one man in 200 and one woman in 500, usually appear in the patient’s late teens or early twenties. Its severity varies enormously but it is likely to be more crippling for men, in whom it often has a greater effect on the spine and pelvis.

Some 40 per cent of sufferers develop iritis or uveitis, and occasionally it affects the heart. As the back becomes increasingly stiff and rounded, chest movements are restricted and breathing may become difficult.

Ankylosing spondylitis has attracted greater attention recently thanks to the introduction of a new group of drugs, the anti-TNF therapies, which can have a miraculous effect on it and many other diseases associated with the HLA B27 genetic cell marker.

These TNF alpha inhibitors are expensive and have not been around long enough for a full assessment of their long-term side-effects. However, they are of proven efficiency, so their use must be considered when antiinflammatory agents and painkillers can no longer enable a patient to continue a normal life.

Although TNF inhibitors have the appropriate European licences for treating ankylosing spondylitis, and have been approved for use in the NHS in Scotland, they have not yet been approved in England and Wales. They are used in other European countries, especially France.

TNF inhibitors have been described as the greatest breakthrough in the treatment of ankylosing spondylitis in its 3,000-year history. Even so, a recent awareness campaign in Scotland showed that 80 per cent of patients with the condition had not heard about them.