Q. A 32-year-old man who is a known case of spondyloarthropathy comes to your office with the persistence of symptoms despite your treatment. You diagnosed his spondyloarthropathy six months ago and started treating him with NSAID. Next, you started naproxen for him. When full dose naproxen was not effective, you switched to celecoxib. Nevertheless, the patient says he has taken a full dose of celecoxib for the past four weeks and feels no improvement in his symptoms. He still complains of severe low back, newly onset neck pain, morning stiffness, limited and painful spine motions, dactylitis in three fingers, and hip and shoulder pain. He does not smoke. The oral temperature is 37.8 degrees Celsius (100.04 degrees Fahrenheit), pulse rate is 78/min, respiratory rate is 16/min, and blood pressure is 124/74 mmHg. Clinical findings are mainly the same as the last visit four weeks ago, except for the Schober test, in which the measurement decreased from 4.1 to 36 cm. X-rays of the spine and pelvis show no new abnormal changes. What is the best treatment plan for him?