Q: I am suffering from ankylosing spondylitis and now it is at an advanced stage. It originally started when I was 40 years old but was detected twelve years later and I did not get any effective treatment. Currently, my vertebra is severely bent, my neck movement is very poor and I face occasional breathing difficulty. Pain is not very acute. Once in a while (after long gaps) I get acute pain from hip down through the thigh. Five years back I had an attack of Iritis 4 times. What is the certain treatment available for arresting further deterioration, even at advanced stage? I am interested to know at which medical institute in India, such treatment is available?

A:The recent trend in the MEDICAL (drug) treatment of ankylosing spondylitis include: 1. Pamidronate infusions once every month. This is a slow acting medicine and requires once monthly admission to the hospital where the medicine is given as intravenous infusions. The success rate is moderate. 2. Anti-TNF agents (infliximab abd etanercept) - very expensive but effective medicines. They cannot reverse the permanent spinal structure damage but at least can prevent active inflammation of the disease. Also, these are effective in controlling the eye inflammation associated with this disease. The main draw backs are two. One, these medicines are so expensive that only a few can buy it in India. Secondly, there is a small chance that dormant tuberculosis may become active in some patients - needing treatment of tuberculosis in such patients. Treatment is being given at the Joint disease Clinic at the Indian Spinal Injuries Centre at vasant Kunj, New Delhi. The same is also being given at the Research & Referral Army Hospital, New Delhi.