Q: My wife who is 31 years old and has a family history of gout, developed seronegative rheumatoid arthritis in 1994. She took allopathic treatment but developed in-grown toenails and bleeding of all toe fingers. Ayurvedic medicines cured her in 4 months. Since last year she has started getting pain in her feet whenever she overworks or walks a short distance. What is the cure? If we plan a second child will he be affected?

A:The field of rheumatology requires a detailed interview and questioning with the patient, only then one can reach a diagnosis. From this stand-point in the present situation I am handicapped to a very large extent. For example, except in most rare situations, generally women do not get gout. Yet you have mentioned that your mother-in-law had gout. Again, you have mentioned shifting pains in different joints in your wife that was diagnosed as 'seronegative rheumatoid arthritis'. This should not be the diagnosis in any patient with shifting pains as in rheumatoid arthritis the pains are additive in the sense that additional joints keep getting involved while the previous joints also remain involved leading to a chronic inflammatory polyarthritis (multiple joints are involved). Finally, the commonest cause of ankle and feet pains is mechanical, mostly related to shoe, walking habits, etc. In the absence of any constitutional symptoms (fatigue, malaise, loss of appetite, night-sweats or low grade fever, etc.), it would appear that the condition is non-inflammatory and likely to be mechanical. A test called erythrocyte sedimentation rate and another one called C-reactive protein (quantitative), could have helped in deciding if the condition is inflammatory in nature. The second common cause is related to a condition called panniculitis, but you have not mentioned any symptom of skin/subcutaneous tissue involvement. Therefore, panniculitis is an unlikely cause in your wife's case. Under the circumstances, I feel that she needs to be clinically examined by a qualified rheumatologist.