Q: I am a 22 years old boy. I suffered from rheumatic fever associated with a mild pain in the wrists about 8 years ago. The doctor had prescribed me Pentid 400 tablets and Disprine for about a year. My A.S.O titre count was over 400 IU/ml at that time. But, after taking the medicine, it became negative and the pain also subsided. So, I discontinued the medicines. About one and a half year ago, I suddenly felt pain in my left knee. In the blood test, I found my R.A factor is 12.3, A.S.O titre is 860 IU/ml and ESR is 33. The doctor prescribed me 12 injections of Pencom LA once every 3 weeks. After 3 months, A.S.O came down to 755 IU/ml. But, I was still feeling mild pain in my fingers and back. After a year of treatment, A.S.O titre again went up to 858 IU/ml. The ESR came down to 22 from 33 and R.A factor became 3.21. The doctor told me that there is no reason to worry if the ESR is lower than 50 and stopped the medicine two months ago. But the pain in knee, back and fingers has not reduced. Recently, I went to a rheumatologist and he told me that the treatment should not be stopped and I have to take this injection lifelong. He has also prescribed Ecosprin 325 for six weeks and Sazo 500 for two months. I have already taken them for 6 weeks but the pain has not reduced completely. He also said that there is strong possibility of body deforming arthritis and heart and kidney damage if I don't take the medicine lifelong. I am really confused and worried about the two contradictory opinions of two doctors. At this point my ESR is 38. Now I am also experiencing mild intermittent pain in my right knee. Please advise.

A:Reading through your message, I am also completely confused. First, I am not aware of any disease in adults (above 15 years of age) that has any thing to do with ASO titre and joint disease except an extremely rare disease called streptococcal reactive arthritis. Therefore, unless the rheumatologist is certain of this rare disease, treatment for ASO-related arthritis may not be justified. Secondly, your symptoms appear to be more like a very common disease called ankylosing spondylitis. However, this disease can be diagnosed only by an experienced rheumatologist who can read the x-ray of the sacroiliac joints with confidence. Also, you will have to get a gene test called HLA B27, done by a special technique called Nested-PCR-DNA base test for HLA B27. This is essential as usually many laboratories are doing this test by another (useless) technique called flow-cytometry which, gives wrong results.