A case of Ankylosing Spondilitis

Hello every one ,I just want to discuss a case of Ankylosing Spondylitis with you .It will be very appreciable for me if you give your kind opinion in this case.

A patient 38 yrs old male, well build diabetic under insulin IM 22 unit is suffering from Ankylosing Spondilitis since 2 yrs.The onset of disorder is gradual and progressive and now he is having extreme stiffness in whole spine .He cannot turn his head 15 degree in both side due to stiffness in cervical spine and cannot bend foreword due to pain and cramp in sacroiliac region. He is having extreme feeling of contraction in hip region which is extending to his groin as if feeling of squeezing in groin. MRI, all blood test (HlaB27),X ray hip, all test suggest positive ankylosing spondylitis with BMD TEST indicate AP spine osteoporosis, dual femur osteopenia. His pain aggravate during initial movement but will not ameliorate after word and bit of burning sensation in both inguinal region due to crampy pain.He used to take regular exercise and can move by his own but with mild foreword bending .Some time when pain aggravates the fever will arrived and subsided by paracetamol(though sazo is prescribed but he didn’t take the medicine).

Generalities-Ambithermal,but maximum time residing in Ac condition, thirst-moderate, perspiration- scanty, urine -no abnormality, no specific order, transparent,(MICRO ALBUMIN PRESENT ),stool- constipation regular,g/i-no acidity ,occasionally mild gass,desire –spice,milk,chilli,aversion –nothing specific, sweet some time, thirst –normal, genetalia-lack of stiffness,flaccid,negligible erection(may be due to diabatic),temperament- monosylabus,mischievious,high ambitious(basically he is businessman, owner of 2,3 company),straight forward, sleep-ok,sometime disturbed due to pain.
Past history-nothing specific ,diabetic since1996,onset of A/S 2006.Family history-father-tuberculosis two time ,rheumatoid arthritis with deformity. Mother-expired due to CVA.

Medicine prescribed-phosphorus-200/4DOSE,PLACEBO for 10 days----aggravation of pain for 3 days than reduced 40%,stiffness in cervical region reduced ,pain in nape of neck reduced, pain continuing in hip, stiffness in glutial muscle, with mild burning, walking with forward bending.2nd visit: Placebo for 12 days-pain unchanged, mild pain return in cervical region, stiffness in sacroiliac joint, stiffness extend to groin and hamstring.3rd visit: phosphorus-1M/4 dose, Placebo for 10 days-stiffness in cervical region reduced, hip pain reduced, cramp in groin continuing, burning reduced.4th visit-Placebo for 15 days-pain unchanged, groin pain and stiffness aggravate but cervical pain same like before (40%)reduced.5th visit-palcebo-12 days-all pain aggravate even cervical pain with extreme rigidity.6th visit-Radium brom -1M /4dose-pl for 10 dose-pain unchanged,7th-P/L12 dose-no change.8th visit-Sepia0/1for 12 days,and Sepia-0/3for next 12 days- Pain markedly reduced for 15 days but pain return back with stiffness in hip and feeling of squeezing in hip joint with fever, subsided by parectamol and voveran.9th visit-now this time Lycopodium-0/1 for 14 days after repertarysation –pain and stiffness reduced30% burning sensation in hip and inguinal region abscent,stiffness persist in hip,5%sensation appear in penis(previously no sensation at all).

Now what next, should I go for same medicine, or I have to rethink the case again and if so than which way I should think. Thanks to you as you are showing your interest in this case. Waiting for your reply.
Dr.A.DUTTA,KOLKATA.