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How can ankylosing spondylitis be managed?

Q: I am a 27 years old male diagnosed with ankylosing spondylitis and have tested HLA B27 positive. I was advised to take physiotherapy sessions and was prescribed these medicines - Myoril (4 mg), Pan 40 and Indocap. Almost six months have passed and now I am doing the recommended physiotherapy exercises at home. I have not been taking the prescribed medicines for the last four months. I would like to know whether it is really important for me to take these medicines or I can just keep myself physically active to control the stiffness. Recently, I saw a TV advertisement which claimed that oil can cure arthritis. Is it true?

A:Ankylosing spondylitis is the second most important serious inflammatory arthritic disease after rheumatoid arthritis. There have been fantastic new advances in the field of its evaluation and treatment. However, unfortunately, the evaluation procedures to 'measure' the severity of disease activity is not taught to average doctors, not even to orthopaedicians. Only the rheumatologists (Physicians trained in the evaluation, diagnosis and treatment of joint diseases) are trained in the proper evaluation of the condition. Therefore, the first and the foremost advice would be for you to be under continuous follow-up of a well-trained rheumatologist.

Secondly, in the February issue of 2005, the famous rheumatology journal called 'Arthritis & Rheumatism' (first author of that paper is Wander, from The Netherlands) had reported a study clearly showing that continuous use (as against only when pain occurs) of any of the group of drugs called NSAIDs / coxibs (that are pain-killers for ordinary people) are actually the drugs that act at the root-cause of this disease. Therefore, they should be continuously taken at least for 2 years - non-stop. Of course this treatment is to be taken under close follow-up of the treating rheuematologist with regular periodic 'Disease Activity Score' evaluation.

If this treatment does not lead to the fall in disease activity score to normal levels, the second category of drugs are to be used. They are called by a generic name 'TNF-alpha - inhibitors'. Two of these biologic agents are available in India namely infliximab (brand name 'Remicade') and etanercept (brand name 'Enbrel'). Only the treating rheumatologist, after appropriate assessment of the disease activity, would be in a position to give appropriate advice regarding the use of this group of drugs.

Physiotherapy must continue along with a very active life-style to prevent deformity and obesity. Smoking must be given up in case the patient smokes otherwise, the drugs would not have adequate effect. Do not go for unproven and unscientific 'magic cures' - the type of things that you have mentioned. These must be some unscrupulous persons trying to make a fast buck on the helplessness of some of the patients. I consider such practises unethical.

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