instruction: hello doctor I have been having pain around my lower ribs towards the back side left side since the past eight days the pain gets worse while lying down and trying to change sides in the night it also hurts while sneezing or coughing feels better if I cough or sneeze by holding the area with my hand it hurts a little sometimes while deep breathing while sitting or standing straight the pain is almost not there and also it does not hurt while bending forward or backward but it hurts a little while bending sideways I did a course of hifenac max for days and the pain did come down slightly however it again got bad last night I was diagnosed with ankylosing spondylitis in 2009 since then I have had two episodes of severe pain in my lower back right side sacroiliac joint but it has never pain in the area of ribs like what is happening now I have also had multiple episodes of uveitis over the past eight to nine years I am hla b27 positive I do not have any other symptoms my appetite is fine and I do not feel any other discomfort my motion is regular also I am not on any regular medication my be is normal measured using an electronic commercial machine at home and my vitals were mostly normal apart from slightly high cholesterol when I did my health check up years back
output: hi in the light of the fact that you are ha b27 positive the pain that you are experiencing is due to the same problem this is called enthesitis and it occurs due to inflammation at the attachment of muscles to bones so the treatment also remains similar to that of as you need to take a full dose of said non asteroidal anti inflammatory drugs whichever suits you best for the present you could take voveran so 75 twice daily with an antacid like pantocid if things still bad sulfasalazine may be added calcium and vitamin must be continued regular physical exercise is a must to control this disease please make sure you follow this I hope this helps