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Suggest Treatment And Management Of Ankylosing Spondylitis
My name is Shafiqur Rahman .I am 34 years old.My height is 5 feet 11 inches. My weight is 78 kgs. I am doing a private job in Bangladesh.I have been suffering Ankylosing spondylitis from 2003 when it was first detected through the test of HLA-B-27. I was under treatment of a Rheumatologist Professor Dr Syed Atiqul Haq (MBBS, MD,FRCP,FCPS) from 2003.During this period I have taken the exercise (NASS booklet) as per prescribed by Doctor & following medicine:i)Salazine /Salazopiryn(Sweden) ii)Inhibita iii)Pain killer(voltalin SR,Diproxin CR). But in the year of 2009 I feel very bad, my neck movement is restricted, feels weak, ankle pain and I become sick & weight lose severely. Than I stop to take medicine of Salazine and go to a Chiropractic (Physiotherapist). She suggests me to avoid all kind of Drugs and take cirotherapy (Physiotherapy) regularly. After taking therapy of one month I feel little bit better and did not take any medicine except pain killer which is prescribed by Dr Atiqul Haque(Rheumatologist) from last two years. In spite of that therapy my ankle pain and swelling exists. I can’t walk properly because of ankle & knee pain.In the year 2010 I have done the following test & Xray: Test Result 1)Lumbo-Sacral Spine B/V Bilateral sacroilitis ,Ankylosing spondylities 2) Cervical Spine B/V No significant abnormality is defected Now I take therapy one day in a week and take a Pain killer Reumacap SR (Indomethacin USP 75 mg) once daily but my two ankle swelling is not so well. I can’t walking properly, mobility of the leg is decrease, can’t sit in the floor, I can not stand in a place long time and also I feel very week. Now I want proper & advance treatment on AS.What can I do & want to proper treatment immediately. Please suggest me asap. Thanks Mohammad Shafiqur Rahman. Email: YYYY@YYYY
Tue, 31 Mar 2020
Hi,
First of all, I have to say that diagnosis of AS is not by HLA-B27. This test only supports the diagnosis when we suspect AS by history, lab data and other tests (such as ESR, CRP). Your important finding is sacroiliitis on X-ray. The physiotherapist has made a big mistake by telling you to stop medication. you should know that AS is a rheumatologic condition and medication is a mandatory part of the treatment, although physiotherapy and/or chiroraxy could be of benefit.
Overall, you should have a combination of treatments. First of all, Indomethacin, 75 mg/day has little anti-inflammatory effect. Usually, I prescribe 75 mg, twice daily to get the full anti-inflammatory effect of this drug (consult with your doctor on this). Also, you should have some physiotherapy sessions from time to time. Chiropraxy does not help a lot, because the nature of your problem is inflammatory, not mechanical. I suggest aquatic therapy. You can walk and perform mild exercises in the water. Another important point is avoiding high impact exercises and activities such as biking, and jumping.
A regular, moderate intensity activity such as stationary bicycling, or high speed walking or swimming could of great help if done regularly. you will see the results after 4-6 weeks.
Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Hooman Mahmoudi, Neurologist
First of all, I have to say that diagnosis of AS is not by HLA-B27. This test only supports the diagnosis when we suspect AS by history, lab data and other tests (such as ESR, CRP). Your important finding is sacroiliitis on X-ray. The physiotherapist has made a big mistake by telling you to stop medication. you should know that AS is a rheumatologic condition and medication is a mandatory part of the treatment, although physiotherapy and/or chiroraxy could be of benefit.
Overall, you should have a combination of treatments. First of all, Indomethacin, 75 mg/day has little anti-inflammatory effect. Usually, I prescribe 75 mg, twice daily to get the full anti-inflammatory effect of this drug (consult with your doctor on this). Also, you should have some physiotherapy sessions from time to time. Chiropraxy does not help a lot, because the nature of your problem is inflammatory, not mechanical. I suggest aquatic therapy. You can walk and perform mild exercises in the water. Another important point is avoiding high impact exercises and activities such as biking, and jumping.
A regular, moderate intensity activity such as stationary bicycling, or high speed walking or swimming could of great help if done regularly. you will see the results after 4-6 weeks.
Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Hooman Mahmoudi, Neurologist
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