Managing Ankylosing Spondylitis: Medication, Exercise, and Inflammation Concerns - Internal Medicine

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Managing Ankylosing Spondylitis (AS) can be complex, especially when dealing with medication efficacy, exercise, and inflammation concerns. Let's address your questions one by one.

1. Medication Efficacy Over Time: It is indeed possible for medications like Secukinumab (brand name Cosentyx, which you referred to as 希樂葆) to become less effective over time. This phenomenon is known as "secondary loss of response." In some cases, the body may adapt to the medication, leading to a decrease in its effectiveness. If you notice an increase in pain and inflammation despite consistent use of the medication, it is important to discuss this with your healthcare provider. They may consider adjusting your dosage or switching to a different medication.

2. Impact of Vaccination on Medication Effectiveness: The BNT vaccine (Pfizer-BioNTech) is primarily aimed at preventing COVID-19 and does not directly affect the efficacy of AS medications. However, some patients report changes in their autoimmune disease activity following vaccination. This could be due to the immune system's response to the vaccine, which may temporarily alter inflammation levels. It’s advisable to monitor your symptoms and discuss any changes with your doctor.

3. Diet and Immune Response: While a healthy diet, including fruits and vegetables, can support overall immune function, it is unlikely that dietary changes alone would significantly impact the effectiveness of your AS medication. However, if you have made drastic changes to your diet or if you have developed food sensitivities, it might be worth discussing these changes with your healthcare provider.

4. CRP and hsCRP Levels: C-reactive protein (CRP) and high-sensitivity CRP (hsCRP) are markers of inflammation. The standard reference values can vary slightly depending on the laboratory and the specific assay used. Generally, a CRP level of less than 0.5 mg/dL is considered normal, while hsCRP levels can range from 0.0 to 0.3 mg/dL for low risk, 0.3 to 1.0 mg/dL for average risk, and greater than 1.0 mg/dL for high risk of cardiovascular disease. For AS patients, it is essential to keep track of these markers as they can indicate disease activity.

5. Exercise with Sacroiliac Joint Pain: If you are experiencing mild pain in your sacroiliac joints, it is still generally advisable to engage in gentle exercises as outlined in the AS education manual. However, it is crucial to listen to your body. If certain movements exacerbate your pain, you should modify or avoid those activities. Low-impact exercises such as swimming or cycling can be beneficial and less stressful on the joints.

6. Playing Badminton with Sacroiliac Joint Pain: Engaging in sports like badminton can be more challenging if you are experiencing pain in your sacroiliac joints. While physical activity is essential for maintaining mobility and reducing stiffness, high-impact or twisting movements may aggravate your condition. It would be wise to consult with your physical therapist or healthcare provider to determine if you can safely participate in badminton or if modifications are necessary.

In summary, managing AS requires a multifaceted approach that includes medication, exercise, and regular monitoring of inflammation markers. It is essential to maintain open communication with your healthcare team to adjust your treatment plan as needed. If you experience any significant changes in your symptoms or have concerns about your current treatment, do not hesitate to reach out to your doctor for further evaluation and guidance.