<s>[INST] Female, aged 73, wight approx 68k, height 5ft 4in, history of depression. Diagnosed ankylosing spondylitis aged 30 [but severe back pains since 19 years], with iritis, and HLA 27 blood test positive. I have had all the usual drugs; NSAIDs make no difference, MTX, sulfasalazine not much difference, high doses of prednisolone [60mg per day, reducing by 5mg every 3 days for iritis] very good for pain relief, but unsustainable long-term. NOW, August 2015, all joints painful and stiff, especially mornings, no energy and little enthusiasm. I Live in Sri Lanka, so always warm! What do you suggest? ANGELA SANDERS [/INST] hiPhysical therapy is a very helpful thing in such cases apart from symptomatic pain medicines.You may also consult an rheumatologist if any biologic or newer medicines would be of any helpbest wishes </s>