Hi, thanks for posting your concern in the HCM. From the information I think you have active Spondyloarthropathy. For this you are on TNF inhibitor and Sulfasalazine. And the treatment I think is appropriate. What you should know that in both ankylosing spondylitis and undifferentiated Spondyloarthropathy fatigue occurs in more than 50% patients. So does back pain as well. Sometimes symptoms improve with exercise. The elevation of the acute phase reactants, esr, crp, may suggest active disease or ongoing inflammatory process. So, they may be elevated in such patients with active disease even in the absence of any other infection or disease. But, one thing is important. Etenercept is very commonly associated with development of respiratory tract infection. Therefore, my recommendation is you please consult your treating doctor to rule out any exacerbation of the activity of the current disease or emergence of new infection. For any further questions please write back to us. Regards. Dr. Kaushik