Q: I am a 22 years old girl with an ASO titre of 590 IU/ml and severe joint paint with sore throat and fever. I have polyarthritis too. I want to know if this is rheumatic fever? At the same time even my menstrual cycle is not regular and appetite is low. I am puzzled with my problem. Please suggest what to do? I am a microbiologist and know it is due to infection but the doctors are not suggesting any penicillin injection. Please help.

A:It is important to know that the first episode of rheumatic fever never occurs after the age of 15 years. Moreover, the joint pains in rheumatic fever never persists in any joints, it disappears after a few hours then moves to any other joint for another few hours. This is why the joint pains of rheumatic fever is called ‘fleeting in nature’. Lastly, there is always heart involvement in rheumatic fever that can be detected by sensitive latest ECHO-cardiography machines by specialist cardiologists. Because of the above reasons, ASO test should never be done in adults with joint disease who have crossed the age of 15 years! Under the circumstances you must immediately contact a well-trained experienced rheumatologist (not orthopaedician surgeons who are not trained in evaluating, diagnosing and treating joint diseases), for appropriate evaluation and proper advice regarding treatment.