1. Psoriatic Spondyloarthritis (PSA) + Reactive arthritis :-

A 44 year old male patient, Mr. R, who is a civil engineer by profession came to Dr. Appa Rao’s clinic on 30 Nov 2011 with complain unable to walk freely and swelling of left knee and left ankle. He gave history of RTA (Road Traffic Accident) fall from bike on 8 Oct 2010 – (1 year back). Since then history of polyarthritis involving ankles, knees, wrist, metacarpophalangeal joints of both hands since 6 months. He also had Joint swelling with early morning stiffness since 3 months and history of pain at back and sacral region since 2 months.

He had taken various treatments from various doctors but without any improvement. A local doctor treated him symptomatically with analgesics and crepe bandage for ankle and knee. He again visited him after 15 days i.e., on 26 Oct 2010 with c/o vomitings, loose motions, fever,headache and myalgia. He was investigated for malaria and urine routine. Then he visited an Orthopeadic surgeon in on 10 Nov 2010. He was advised MRI left knee which revealed – medial meniscal tear and planned for Arthroscopy if complaints persists even after 2 months of treatment. Then he was referred to a Rheumatologist, on 26 Nov 2010. Patient gave H/O low grade fever and diarrheoa at the beginning of polyarthritis of knee and ankle and thus diagnosed as Reactive arthritis , ligamental injury, post viral fever and post Enteritis. Meanwhile his disease he continued it till 30 March 2011. Then he visited same orthopeadic surgeon on 11 April 2011. By that time he developed bilateral Saccoilitis, peripheral arthritis and came with complaint of severe back pain. Then he was diagnosed as Psoriatic Spondyloarthritis (PSA), Reactive arthritis. He was started on with methotrexate and took physiotherapy too for almost 8 months. Meanwhile he was tested positive for Montoux Test with latent Kochs. On 28 Nov 2011 – very disappointed with the treatment he gave history of “NO CHANGE IN PAINS WITH MEDICATION”And then he visited Dr. Appa Rao’s clinic on 30 Nov 2011 and started his immunonutrition therapy and we can see the change in his subsequent videos. Dr. Appa Rao took two months time to reduce his inflammation and also and also seen that the ESR comes down to 50mm from100mm. He improved so much that in 2 weeks only he was able to walk without limping. Day by day he kept improving and became totally fit in a period of 3months. The patient is well recovered and resumed job. He is on maintenance therapy and is doing well since then.

2. Seronegative Spondyloarthropathy :-

This is about 15 year old boy named G. His symptoms started in 2009 with pain in right knee, then slowly involving different joints- left knee, right ankle, left metatarsophalangeal joints, right shoulder pain, right sternoclavicular joint pain. He was being managed symptomatically with NSAIDS and methylprednisolone till June 2010. Then he visited Rheumatology department in a medical college hospital.He was investigated and was found to be RA negative and ANA weakly positive. His X-ray left knee revealed mild effusion and there was H/O fever on and off. His CRP was positive and ESR first hour was 60 mm/1hr. Then he was started on Methotrexate 2.5 mg from July 2010. Ultrasound abdomen done in Aug 2010 revealed mesentric adenitis He started with Dr. Appa Rao’s immunotherapy and doing good till date.

3. Progressive Systemic Sclerosis (PSS) or Scleroderma :-

This is about 43 year old female patient who is a known case of progressive systemic sclerosis (PSS) or scleroderma. PSS is a generalised disorder of connective tissue in which there is thickening of dermal collagen bundles, fibrosis and vascular abnormalities in internal organs. Her complain started with smaller joint pains of hands in the year 2004. Her ESR levels were 110mm in the year Jan 2004. She was diagnosed as scleroderma somwhere in the year 2006. She visited Rheumatology Centre, on 22nd Jan 2007. She took treatment there for almost on year till Feb 2008. She was started with Azoran 50mg twice daily from Oct 2007 to Jan 2008. But her symptoms did not improve and she started complaining of stress aggravated pain, loss of appetite and generalized weakness.

Her blood report shows anemia with hemoglobin 8.8 gm/dl. She complained of burning sensation in both feet. Then in April 2008 she changed her doctor and consulted another in Rheumatology Clinic. At that time her hemoglobin was 6.8 gm/dl and her C reactive protien was 46.9 mg/dl. She was managed with methyl prednisolone 5 mg and was again started with Azoran 50 from Aug 2008. Then in Nov 2008 she complained of left sided chest pain. In March 2009 she was diagnosed as PSS with TB lymphadenopathy. She was started with anti tubercular treatment. But her joint pains increased and she started developing finger deformities in both hands. She continued with that doctor till Jan 2011, i.e., almost 3 years but with no positive results. At this juncture she has visited Dr. Appa Rao and started his treatment. She has recovered from her pains and all her movements are improved and the deformities occurred earlier were arrested and no more further deformities occurred thereafter. Her Hemoglobin levels increased to 11mg/dl and her ESR levels decreased to 45mm. She is taking the follow ups and leading a normal life till date.

4. Seronegative Spondyloarthopathy :-

This is about 40 yrs old female Z suffering from Seronegative spondyloarthropathy. Patient came to Dr. Appa Rao’s clinic on Jan 2014 with complaints of joint swelling in elbow, knees and severe backache and swelling all over the body since 2 years i.e. from 2012. Patient had complaint of pain abdomen with nausea, vomiting and loose motions since 3-4 years for which she was investigated and was diagnosed with intestinal tuberculosis(TB) and chrons disease in 2010. She was then started with category III ATT for 9 months in June 2010. Meanwhile she was also started with Pentasa(Mesalamine/5-aminosalicylic) 3g/day for treatment of inflammatory bowel disease. She was still continuing Pentasa for her IBD but with partial relief. She still complained loose motions and pain abdomen. Then she was started with Azoran 50mg(Azathioprine) in Dec 2010.

Her ATT stopped in July 2011. But at this point of illness she developed back pain which gradually progressed to joint swellings all over the body. Thus diagnosed with seronegative arthropathy in March 2012. She continued with pentasa and azoran 50mg but with no relief in IBD and joint pains. Then in Jan 2013 her pentasa was stopped and azoran 50 mg OD was continued. Then in Dec 2013 azoran was increased to 100 mg OD. At this point of her disease with not much relief inspite of 3 ½ years of treatment, exhausted with this long course and cost of the treatment, she came to know about Dr. Appa Rao’s and started his immunotherapy on 6 Jan 2014. After 2 months, her Azoran dose was reduced from 100mg to 50 mg and then in Aug 2014 her Azoran was stopped completely. She responded so well that she is still continuing this treatment and this is evident from her ESR reports which shows remarkable drop in levels in just 8 months after starting treatment which is still maintained.

This shows her chronic inflammatory response is under check with this immunotherapy thus relieving her Seronegative arthritis(SNA) complaints and helping her to lead a pain free life.

5. Seronegative Spondyloarthropathy :-

This is about 24 year old man Mr.M suffering from Sero-negative arthritis. Patient was apparently asymptomatic till May 2016 when he developed sudden and severe pain associated with stiffness of back and knees and slowly it progressed to shoulder joints. He was unable to sit and squat. There was little pain in walking and bending too. Then he consulted an orthopedic and was started on corticosteroids and NSAIDS but with little improvement. They did many investigations but everything turned out to be normal and still the patient was suffering. Then almost after 10 months of continuing this treatment he came to Dr. Appa Rao’s clinic.

In April 2017 he visited Dr. Appa Rao and started his immunotherapy on 14 April 2017. When inquired about his past illness he gave history of anal fissure in May 2015 and history of dental caries and bleeding gums since two years. Thus this could be the major immunological insult resulting in chronic inflammation of his spine, shoulder and knee joints. Thus when started on Dr. Appa Rao’s immunotherapy he responded so well and could feel 60% better by the end of one month which is clearly evident from his videos where one can clearly notice the differences in his gait from his first to latest visits. His difficulty in sitting squatting improved so much that he could almost jump and squat down by the end of July 2017. He is still continuing his therapy and doing good till date.

6. Seronegative Spondyloarthropathy :-

This is about 42 year old female patient Mrs. N suffering from seronegative spondyloarthropathy since 2008.

This patient visited Dr. Appa Rao’s clinic in March 2013. She presented with severe joint pains of both upper limbs and lower limbs along with small joint pains. She was unable to stand and walk without support. There was bilateral pedal edema, pitting in nature. She gave history of on and off rash on thighs and legs. There was history of on and off fever since 5 years. She was a known case of Hyperthyroidism. Patient’s complaint started somewhere in mid 2008. She took painkillers for pain till December 2009. Then in December 2009 she visited a famous joint replacement surgeon. There she underwent some investigations which revealed her as RA factor – positive, CRP – Positive, ASO titre – positive, ANA – positive and centromere B – positive. There was maculopapular rash over left leg and over face. Thus based on these reports she was diagnosed as Seropositive Rheumatoid Arthritis with ? Dermato myositis. Based on this she was started on steroids, hydrochloroquines and Methotrexate. Then after 2 months in Jan 2010 she developed swelling of left leg and foot associated with pain. She was advised colour Doppler of both lower limbs of arterial and venous system, but it was negative for Deep Vein Thrombosis.

Then she went to rheumatology Department of hospital in February 2010. There she was diagnosed as RA seropositive stage-II erosive and active stage with bilateral cellulitis of legs. Then she was continued on same treatment with Folitrax and prednisolone. She continued in hospital till October 2010.

Then she went to one more Rheumatology Clinic and consulted one more senior Rheumatologist. He also prescribed her same Folitrax with steroids which she continued till March 2013. But instead of improvement there was worsening of symptoms and she also developed deformity of wrists and fingers. At this stage of illness she visited Dr. Appa Rao’s Clinic and started his immunotherapy. She has recovered very well and her general condition is good till date. She is on intermittent doses of immunotherapy.

7. Seronegative Spondyloarthopathy:-

This is about 25 year old male patient Mr. P suffering from Seronegative Spondyloarthopathy came to Dr. Appa Rao’s Clinic in severe pains and unable to walk. A 25 year old young male suffered severe back ache and difficulty in walking in September 2011. He consulted an Orthopedic Surgeon who after doing preliminary tests advised him for MRI of both the Hip Joints and Lumbo-Sacral spine. The reports revealed increased signal seen in the sacrum and ileum adjacent to the left sacro-iliac joint on MRI images suggestive of SACRO-ILITIS. There was a Degeneration of D12/L1 and L5/S1 intervertebral disc. His ESR first hour was 105mm and He was RA Factor Negative. Thus he was diagnosed as seronegative spondyloarthopathies. He was put on Methotrexate and sulfasalazine with folic acid. As his symptoms were not improving he came to know about Dr.Appa Rao and came to him in January 2012. He started his Immunotherapy and to his surprise he improved dramatically in just 15 days. When he came he was in severe pains. He took leave from his policeman job as he could not even walk . But then after starting Immunotherapy he was almost 75% better and relieved of his symptoms in just 2 months.

He completely recovered in 4 months and could jump without any pain. You can see his recovery in his subsequent videos. He joined his duty back in April 2012. He is on intermittent therapy now and doing well till date.