I am a 32 years male suffering from ankylosing spondylitis from past 2 and half years. I have been taking jakura5 (tofacitinib) for past 8 months, but my esr and crp levels are not decreasing. I get severe back pain at night which disturbs my sleep, however there is no pain during day time, mostly due to my routine exercises in the morning. Hence kindly inform me what could be the reason of the pain in spite of taking medicine.

Dr. Julie Mercy J DavidPhysiotherapist26yrs exp

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Ankylosing spondylitis ankylosing spondylitis is a cause of back pain in adolescents and young adults. Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints chronic inflammation in these areas causes pain and stiffness in and around the spine, including the neck, middle back, lower back, and buttocks. Over time, chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis causes loss of mobility of the spine. Pt treatment deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Are also advised to sleep on a firm mattress and avoid the use of a pillow in order to prevent spine curvature. Aerobic exercise is generally encouraged as it promotes full expansion of the breathing muscles and opens the airways of the lungs. Home remedies physical therapy for ankylosing spondylitis includes instructions and exercises to maintain proper posture. This includes deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Since ankylosis of the spine tends to cause forward curvature (kyphosis), patients are instructed to maintain erect posture as much as possible and to perform back-extension exercises. Patients are also advised to sleep on a firm mattress and avoid the use of a pillow in order to prevent spine curvature. Ankylosing spondylitis can involve the areas where the ribs attach to the upper spine as well as the vertebral joints, thus limiting breathing capacity. Patients are instructed to maximally expand their chest frequently throughout each day to minimize this limitation. Physical therapists customize exercise programs for each individual. Swimming often can be a very beneficial form of exercise, as it avoids jarring impact of the spine. Ankylosing spondylitis need not limit an individual's involvement in athletics. People can participate in carefully chosen aerobic sports when their disease is inactive. Aerobic exercise is generally encouraged as it promotes full expansion of the breathing muscles and opens the airways of the lungs. Cigarette smoking is strongly discouraged in people with ankylosing spondylitis, as it can accelerate lung scarring and seriously aggravate breathing difficulties. Occasionally, those with severe lung disease related to ankylosing spondylitis may require oxygen supplementation and medications to improve breathing. People with ankylosing spondylitis may need to modify their activities of daily living and adjust features of the workplace. For example, workers can adjust chairs and desks for proper postures. Drivers can use wide rearview mirrors and prism glasses to compensate for the limited motion in the spine. You should check with your doctor before using compression socks for your swelling. These special socks should be properly fitted for you and your needs. Also, be sure to wear them during the day and remove them before you go to bed. Leg elevation if you stand a lot during the day, try propping your feet up or soaking them in water when you get home to help prevent swelling. Muscle relaxant: reduces muscle tension and helps relieve muscle pain and discomfort. Transcutaneous electrical nerve stimulation (also known as tens) is something which helps ease muscle pain and spasms. You can strengthen the muscles by doing tonificationie. Improving the tone of the muscles by adding either weight cuffs / sand bags which will help you to improve the strength of the muscle.  

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