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A 54-year old male presented with chronic low back pain without radiation and significant early morningstiffness of 10 years duration and pain in both knees for the last 5 years. History revealed black staining ofinnerwear (brief) following micturation since childhood. On physical examination, kyphoscoliosis, paraspinalmuscle imbalance, restriction of the ROM of lumbosacral spine, knee tenderness and pigmentation of earand sclera were found. Radiologic features like narrowing of disc space with disc calcification and fusion ofdisc in lumbosacral segment, osteoarthritis of knee pointed towards the diagnosis and biochemical findingof positive urinary homogentisic acid confirmed the diagnosis of alkaptonuric (ochronotic) arthritis.Prophylactic dose of ascorbate was started. Initially NSAID and later acetaminophen were used for paincontrol. Spinal orthosis was given and therapeutic exercise programme instituted. Analgesic use was significantly reduced after 3 months. VAS (pain) score, WOMAC score, hand to floor distance, 50 feet walktime, Patient & Physician Global Assessment etc. were used to monitor LBP and knee pain. All the outcome measurement tools showed significant improvement at 3, 6, 9 and 12 months. Patient’s work place fitness also improved significantly as measured by the number of sick leaves per month.