Q: I am a 46 year old, married lady, weighing 115 lbs and have two children aged 20 and 13. I have a problem of pain in my hands specifically in the palms and fingers, also in my legs, more severe in my feet and calf muscles when I flex my hands or feet. I am taking vitamins regularly, and follow a healthy, mostly vegetarian diet that includes at least 2-3 glasses of milk everyday and plenty of fresh fruits and vegetables. I also drink at least 8 glasses of water. I also have Thalassaemia minor, which does not allow my Haemoglobin to go beyond 9 or 10. I'm taking the following vitamins: Neurobion Forte (B-Complex) once a day. Folvite (Folic acid) 5 mg once a day. Fish oil (Omega3) 1000 mg once a day. Conviron-TR (Iron) capsules (Haematinic with timed released iron) every three months for fifteen days. Calcirol calcium) 1 gram sachet once every 3 days with milk. I normally sleep about 6-8 hours each night. When I sleep for about eight hours, the pain is somewhat less but does not go away. The pain is always less after I wake up then steadily gets worse as the day progresses. I am a housewife and do ordinary household chores such as light cooking and cleaning. I do about 20 minutes of Yoga about 2-3 times a week and light movement dancing about 20 minutes twice a week and light walking 20 minutes three times a week. If I do anymore exercise, the pain gets worse. Massaging my feet and hand gives me comfort but the pain returns as soon as massaging stops. In the last one year, I have repeatedly tested negative for Rheumatoid Arthritis. Can you please suggest what I might be able to do to find out the root cause of the problem?

A:Although you have not mentioned exactly how long you have been suffering from these complaints, this appears to be a chronic ailment. It is unlikely that you suffer from an inflammatory joint disease such as rheumatoid arthritis, wherein symptoms are worst in the morning and physical activity would make them better. Also, joints tend to swell up and even deform with persistence of this disease. People with benign joint hypermobility syndrome (loose joints) could have complaints like yours. A rheumatologist can confirm this diagnosis by a simple physical examination. Another possibility is hypothyroidism. This can be ruled out by testing blood for TSH levels. This condition is well known to cause musculoskeletal pains. Lastly, you may be suffering from premature osteoarthritis. Again, this will require a consultation with a rheumatologist. I do not think your symptoms are due to a dietary deficiency.