Q: I am a 29 years old woman having seronegative spondyloarthritis / ankylosing spondylitis. The pain initially started in my right hip joint and it kept moving from right to the left hip joints. I am currently taking anti-TNF Remicade infusions (took 4th infusion around a month back). The doctors said that there is a damage in the hip joint and my SI joint is fused.

1. What does Remicade do? Will it affect my immune system?
2. Since I have started Remicade, does it mean that I can never stop taking it?
3. I would like to try ayurvedic treatment for my problem. What is your advice?
4. What kind of diet should I follow? The doctor says that I don't need to be on any diet but I must monitor my weight. My present weight is 62 kg and I am leading a healthy life. I don't smoke or drink. My HLA B27 is negative. I used to go to the gym at least 3 times a week and do sports like swimming, rock climbing and yoga, etc.
5. Does extreme weather condition, like winter with snow, be the reason of my problem?

A:To answer your questions:

1. Anti TNF infusions affect only a component of your immune system but they do not impair your entire immune system. Yes, it does reduce your immunity to some infections. Your physician would already have checked you out for infections like tuberculosis before starting treatment.
   
   
2. There is no clarity on total duration of therapy. The disease itself has a natural history and need not stay active throughout the course of your life. Treatment is based on the activity of ankylosing spondylitis disease process in your body. So, you will have to be in touch with your physician for the duration of therapy, and he will assess the activity of disease and then plan your therapy. Patients have had treatment for 18 months to two years also.
   
   It is important to differentiate between pain from activity of the disease and pain from residual damage that has already occurred. You have mentioned that your hip joints already show damage.
   
   
3. Ayurveda is a completely different system of medicine it has a component of physical therapy and a component of internal therapy. The internal therapy medicines by and large may not interfere with your allopathic treatment. However, at times we are not aware of the pharmacological content of the Ayurvedic medicines, therefore we cannot always predict interactions. Usually these are not a problem as the doses are small in Ayurvedic medicines. But beware of fraudulent preparations, which mix allopathic medicines with Ayurvedic medicines. The interactions may be substantial in some of these.
   
   
4. For arthritis like ankylosing spondylitis, there are no special diets we recommend. However, remember it is good to have a balanced diet and obesity can be a major problem for arthritic patients as their physical activity gets restricted and they do not get to burn calories as well as the non-arthritic patients.
   
   From your history you were indeed an active person therefore, it is important for you to stay as active as possible. While rock climbing may be difficult with your hip problem but swimming could be a very useful exercise for you. In addition, the capacity of chest expansion gets reduced in ankylosing spondylitis therefore, it is important to regularly do deep-breathing exercises.
   
   
5. Extreme conditions of cold weather are always uncomfortable for arthritic as in cold weather joints tend to get stiffer and movements are more painful. However, cold does not initiate arthritic conditions like ankylosing spondylitis nor does it influence the activity levels.
   
   
6. Once disease is under control you need to ensure that you have a balanced diet, maintain your weight and stay active physically and intellectually. This is the only mantra to lead a healthy life.