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My nephew was diagnosed back a year or two ago with ankylosing spondylitis. So far, nothing they've done has helped him. Are there any new treatments for this condition?

Ankylosing spondylitis (AS) is a chronic inflammatory condition in a group of diseases called spondyloarthropathies. Young men in their teen years or early 20s are affected most often. Back pain, stiffness, and postural changes are common.

There is no cure for AS. Treatment is centered around patient education and managing symptoms. Because of the inflammation, the first line of treatment is usually non-steroidal anti-inflammatory drugs (NSAIDs).

Physical therapy is a central part of the management program. The patient is set up with a home program of spinal extension exercises, deep breathing, and range of motion exercises. Strength training for core muscles of the trunk are also important. The patient is advised to do these exercises routinely (daily if possible).

More recently, biologic agents called tumor necrosis factor alpha inhibitors (TNF-a inhibitors) have been used with AS. These drugs are very effective in reducing inflammation and preventing flareups. Patients experience decreased pain and increased motion, which results in improved function.

A rheumatologist may be the best doctor to consult with about the best way to treat your nephew. Each patient must be evaluated individually. Finding the right drug at the proper dosage can take a bit of trial and error before the best results are obtained.

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