Q: I have a long standing problem of backache and other joint pains. Recently my ASO titre was raised up to 400 and my doctor started Penidure 12 lac units every week and says that I have to keep taking penicillin injections for the next one year. Am I on the right treatment with regards to my joint pains? Can I conceive during the period of my treatment?

A:Non-specific back pain is related to stress and strain on the ligaments of the lower back - a very common problem among young ladies that is never a life threatening serious problem. It disappears on regular exercise and learning to relax and keeping correct posture. I strongly recommend that you immediately see a rheumatologist (NOT an Orthopaedic surgeon or any other type of doctor) and stop penicillin injections. It is a wrong treatment. ASO titre is not all of any importance in patients with back pain. The following small write-up (recently written by me) would help you (and your doctor) to understand why I am saying so: ANTI-STREPTOLYSIN O ANTIBODY (ASO) TITRE: Test for ASO titre is primarily to demonstrate an antecedent streptococcal infection [Oxford textbook]. In some children and juveniles antecedent streptococcal infection may lead to the development of rheumatic fever and antistreptolysin O has been the most widely used test for this purpose. But, there are serious problems with this test because the titres of antistreptolysin O vary with age, season, and geographical region. They reach peak levels in the young, school-age population. Titres of 200–300 Todd units/ml are common, therefore, in healthy children of elementary-school age (false positive) [Oxford]. On the other hand up to 20% of documented rheumatic fever cases may not show a rising titre (false negative). Moreover, it is to be noted that persistent arthritis never occurs in rheumatic fever. Also, back pain is never a feature of rheumatic fever. Another important feature of rheumatic fever is almost a universal occurrence of carditis even at an early stage easily demonstrable with sensitive new (echocardiographic and/or elcetrocardiographic) techniques in most patients. Lastly but not the least, first episode of rheumatic fever never occurs beyond 12-15 years of age. Therefore, the following points may be noted regarding ASO titre and its use in rheumatological practice: Firstly, never requisition this test in patients above 15 years of age; never requisition this test if the patient is having persistent arthritis (> 6 weeks). Never requisition this test in patients with back pain, as back pain is never a manifestation of rheumatic fever. Lastly, even in the presence of significant titres of ASO diagnosis of rheumatic cannot be made in the absence of clinical features of rheumatic fever the most important component of which is carditis. The practice of initiating treatment with long-acting penicillin injections in a child, juvenile or an adult simply because there is a positive ASO test is to be strongly discouraged. Similarly, penicillin treatment in a child, juvenile or an adult with persistent arthritis, just because ASO result has been reported as positive must be strongly discouraged as it delays diagnosis and treatment of the actual disease (in most cases juvenile idiopathic arthritis) with disastrous outcome.