Q: My 19 years old brother was diagnosed with poly-arthritis a year back and then onwards he has started medication under the guidance of a rheumatologist. After a year, he is experiencing pain in his ribs (more in the left as compared to the right). The doctor told us that it is due to cloudy atmosphere. My father is also suffering from ankylosing spondylitis. For the last one and a half months he is on Tramadol (4-6 daily). His chest x-rays reports are normal. Why is my brother suffering from polyarthritis with rib pain?

A:With positive family history of ankylosing spondylitis, your brother most likely has developed inflammatory spondylitis, with onset with polyarthritis, and he is on the medications as has been mentioned under the care of a qualified rheumatologist. His present symptom of rib pain may be due to involvement of small joints over costovertebral joint or at the costochondral junction. As far as the amount of pain more on the left side than the right, it is natural observed tendency of the disease which affects body joints asymmetrically. If pain is not relieved by these medications, then stripping the rib and guided injection in the involved joint in addition to the appropriate control of inflammation is required. Your rheumatologist should be able to do that.