Q: I have a problem in my leg which I have shown to several doctors. I am now confused over whom to contact further. I have pain in my left hip joint and in foot. I have pain only in the hip joint and after that it has migrated to the foot too. They took an x-ray and said there is no problem with respect to the bone joint. The doctor has given me Tab. Galimac 400 mg, Valz BCD 20 mg and Creval 40 mg. The pain has reduced but not completely cured. The pain is severe in the morning. I got my blood examined and the report is as below: Hb%: 12.3 gm/dl, TLC: 10,100 cells/cumm, Platelet Count: 2.70 lakhs/cumm. DLC - Neutrophils: 64%, (N:50-70%). Lymphocytes: 29%, (N: 20-30%). Eosinophils: 07%, (N: 01-06%). ESR (Westergren method) - 40 mm/hr; RA factor - Negative; ASLO titre - Negative; C-Reactive Protein: Positive; Serum Uric acid: 7.0 mg/dl; SGOT: 15 IU/l; SGPT: 18 IU/l; Creatinine: 1.1 mg/dl. He has given tablets Coxtra 40 mg, hetrazan 100 and injection Penidure once in 21 days for 3-5 yrs. I also have shown to a rheumatologist who said that I have spondyl-arthritis. He gave me Indomethacin 25 mg, Sulfasalazine (Saaz 500), Amitriptaline 10mg. From past 3 days, I have swollen knees, the rheumatologist told me that it has some water in it and will reduce with the above tablets. Now the pain is reducing. My doubt is do I have confirmed arthritis? If so do I need to consult any other doctor?

A:Your symptoms are rather typical of an inflammatory rheumatological disease called spondyloarthritis also known by a more commonly used term ANKYLOSING SPONDYLITIS. It is a genetic disease (related to a gene called HLA B27 that is situated on chromosome number 6). This gene causes a sort of blind-folding of the body's defence system that starts to attack the body itself by mistake (somewhat like a friendly fire when by mistake the army may kill its own civilians). This is why this disease also belongs to a group of conditions called auto immune diseases (i.e. diseases where the immune system attacks its own body by mistake). I am happy that you have been seen by a rheumatologist who has already diagnosed you correctly. You must follow the advice of your rheumatologist. I strongly recommend that you get your swollen knee joint aspirated and then injected with a medicine called TRICORT. Also, discuss with your rheumatologist the results of a latest research report recently published in the famous journal called Journal of Rheumatology. The research reports that a drug called methotrexate appears to be very effective in this disease also (this drug is also very useful in a related disease called rheumatoid arthritis), if given along with Sazo-EN that you are already taking. We have a lot of experience of this treatment and find it very useful. The dose of methotrexate must be escalated to 20 mg weekly injections (tablets are not very effective). Another major discovery in this disease is the use of a new group of drugs called anti-TNF agents. Two of them are available in India by the name brand Remicade and Enbrel. Although they are extremely expensive, they are highly effective is arresting the progression of the disease. I would strongly recommend that you discuss all these points with your rheumatologist. Remember two things: 1. Physiotherapy and occupational therapy remains the main stay of treatment in this disease to prevent deformities. 2. Being a genetic disease, you may have to take some of these medicines for years (like treatment of diabetes or high blood pressure). Hope this would be of help to you.