Q: I am a patient of spondylo-arthritis. I am have pain in my left hip joint and left knee, the knee is swollen too so the rheumatalogist said that it should be aspirated. Is there any chance that the water will be stored again if I aspirate it? I am going for physiotherapy, can I continue doing it? I have been given tablets Sazoen 500, Indomethacin and amitriptyline. Will these help because last week it had reduced to normal but from the last two days there is pain again?

A:In the last 2 years or so the treatment of spondylo-arthritis has changed dramatically. Now, methotrtexate injections (stepped -up to a dose of 25-30 mg weekly) with folic acid combined with intermittent glucocorticoids, and sulfasalazine 1 gm 2 times per day with the most effective drugs called anti-TNF biological drugs (Remicade and Enbrel), is given to completely control the disease. Knee aspiratin and injection with depot-preparation of glucocorticoids (triamcinolone acetonide) i the knee joint is very effective for controlling the disease. But, it is necessary to control the systemic disease with medicines mentioned above otherwise there is always a chance that the disease would relapse. Kindly discuss these treatment issues with your rheumatologist in detail.