Curved Spine, Clear Heart: Dr. Muhammad Asim Khan’s Advice for Seeing the Glass Half-Full

It came down to a matter of taste for Muhammad Asim Khan, MD, FRCP, MACP – during his postgraduate training in London, England in the late 1960s, he recalled, “I didn’t like the hospital food that was served to me. One day I had a taste of Kentucky Fried Chicken and it was so delicious that I decided to go to the US, the origin of this franchise.”

This nugget of tongue-in-cheek humor is characteristic of Khan, whose childhood mystery illness (now known to be juvenile spondyloarthritis) was treated with intravenous infusions of honey in his home country of Pakistan, who later became one of the first board-certified rheumatologists in the US, and whose treatment of spondyloarthritis patients has been delicately informed by his experience as a patient, himself.

Whether KFC or the promise of academic rigor warrants more credit for his stateside move, the Spondylitis Association of America has benefited greatly either way. Khan was one of our co-founder, Jane Bruckel’s, original consultants when she created the organization, and served as a founding member of our Medical and Scientific Advisory Board. Khan’s deep expertise has enriched the SAA’s programs and resources for over three decades, and his gentle humor and optimism have made him an audience favorite at conferences.

A closer look at his story reveals a person profoundly motivated by morals, and an effervescent zest for life.

Born in British India, Khan and his family became refugees when the subcontinent was partitioned in 1947, and they eventually settled in the newly formed nation of Pakistan. Khan was 12 when he started to experience the back pain and stiffness that are hallmarks of spondyloarthritis. Inflammation spread through his lower back and hip joints, and later the joints in his chest. “I had a very severe onset – it hurt to cough and sneeze,” he recalled. But his symptoms puzzled local doctors. “We didn’t have any rheumatologists in those days. Even in the US, rheumatology was not recognized,” he said. “At age 12, my parents contacted a professor of orthopedics. He had no idea about the disease. He didn’t know what to do. Moreover, there was no effective treatment.”

Due to Khan’s chest pain, he was first treated for tuberculosis. His regimen included painful intramuscular injections that Khan learned to administer himself every day. After a year with no improvement, the doctor tried a different approach: He began giving Khan honey intravenously. Now, Khan makes light of this episode. “I tell people that’s why I’m so sweet – because I have honey running in my veins.”

Six years later, when Khan was 18 and a medical student at King Edward Medical College in Lahore, he was seen by a medical professor who correctly diagnosed his illness and prescribed the NSAID phenylbutazone. It was the first effective treatment he received. “It was this medication that allowed me to finish medical school and graduate at age 21,” he said.

Khan was preparing to relocate to the UK for post-graduate training when political upheaval threw a wrench in his plans. India attacked Pakistan in 1965, and Khan volunteered to serve as a medical doctor in the army. “I never told them I had ankylosing spondylitis,” he said. He served for two years and attained the rank of army captain. “I was the only graduating student who volunteered to serve right away, even though I was physically unfit.” Why didn’t he let the examiner know? “I was a refugee and I received almost-free medical education,” Khan said. “I felt morally obligated to serve.”

In England, Khan studied joint replacement surgery – a procedure with particular significance for him. “I spent six months learning how hip replacements and other joint surgery was done, knowing that one day I would be on the receiving end,” he recalled.

Khan landed in Cleveland, OH, 50 years ago, not aware of the news that a week before his arrival, the Cuyahoga river that runs through the city had caught fire due to industrial pollution – an event that finally spurred the creation of the nation’s Environmental Protection Agency (EPA).

Despite having ankylosing spondylitis, Khan didn’t initially pursue rheumatology as his specialty. As a medical student, he was interested in cardiology. But he realized he had difficulty performing standard procedures such as chest massages and mouth-to-mouth breathing. He decided to change course. “I didn’t foresee all the bad consequences of the disease over the years. But being a realistic person, I realized that I could not do full justice to my patients,” he said. “I felt it was immoral to become a cardiologist, so I chose rheumatology.”

Khan was among the first batch of doctors to receive board certification in rheumatology when the exam was first offered in the US. In 1973, he was offered a faculty position at Case Western Reserve University School of Medicine, where, at “75 years young,” he is now a professor emeritus of medicine.

Khan has authored three books, including Ankylosing Spondylitis: The Facts, a book that has sold more than 14,500 copies, and been translated into Spanish, Portuguese, Japanese and Persian. In addition, he has edited four books, and authored 50 book chapters and over 200 scientific articles about AS and related forms of spondyloarthritis (SpA).

He is a founding member of the three premier international organizations interested in research in AS/SpA: ASAS (Assessment in Spondyloarthritis International Society), SPARTAN (Spondyloarthritis Research and Treatment Network), and GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis).

But amid his vast body of work, one project stands out: the self-portrait he painted some 30 years ago. The abstract acrylic piece depicts his middle name, Asim, in three renderings – two in the English alphabet and one in Arabic. In the middle column, he incorporates the letters of his name into his perception of his body, conveying both fragility (the S and I of his curved, fusing spine) and resilience (his clear, straightforward heart). He considers his name meaningfully entwined with his life; the letters A-S-I-M can be read: “AS, I am.” Along with that, he noted with a chuckle, “You can pronounce it ‘awesome,’ which is fine with me.”

These days, although he uses a walker to get around, pain is not part of Khan’s daily spondyloarthritis experience. “I have a high threshold for pain. Once the inflammation goes away, I don’t feel pain. I have been painless for a long time,” he said. It’s an incredible outcome for a man who fractured his neck years ago. But problems like that are merely “hurdles” to Khan – and hurdles can be surmounted.

“For some reason, I developed a type-A personality,” he explained. “I felt that the hurdles are there to be overcome. I was never depressed or worried about what the future holds. People who look at a glass half-full do much better than people who look at a glass half-empty.”

Khan continues to travel and lecture internationally. “If someone had a video camera recording me during my life, the camera man would be surprised at how I achieve everything. I travel globally, alone. I have a CPAP machine. I carry my machine and my clothing and my iPad and I go all over the world.” Even his local travels are noteworthy – Khan can be spotted driving around Cleveland with the license plate HLA-B27, the spondyloarthritis gene.

Being a rheumatologist with AS has given Khan a special sensitivity when helping spondylitis patients. His advice is heartfelt and wide-ranging. “Young people should be taken care of by a physician who has empathy for every patient he or she treats,” he said. Doctors must educate their patients so they can understand both their illness and its treatments. Medications are not one-size-fits-all, but proper treatment can help patients live full lives. Compliance is key. Avoid smoking. Exercise and eat well. And above all, stay away from too much Kentucky Fried Chicken.