Hi, Welcome to icliniq.com. I think we are monitoring the wrong thing. ESR (erythrocyte sedimentation rate) is not a very good indicator for monitoring as it rises fast and comes down very slowly maybe four to six weeks even after the resolution of the infection. I believe she had a urinary tract infection. Was the urine culture done? As she is better after antibiotics, she is recovering.
Hi, Welcome to icliniq.com. I reviewed your query, and based on what you described, it sounds like your mother's medications may need to be adjusted, especially since her joint pain is getting worse. Her lab reports show a high ESR (erythrocyte sedimentation rate) of 71 mm/hr, which typically points to significant inflammation. Here are a few thoughts on her current medications: Methotrexate – The standard starting dose is usually around 15 mg once a week. A dose of 7.
Hello, Welcome to icliniq.com. Well, as per your history, it does look like a diagnosis of polymyalgia rheumatica. I would like to ask you a few more queries related to his illness. When is the pattern of pain more mornings or evenings? Does he experience morning stiffness as well? Any history of weight loss or appetite loss? Any history of jaw pain or headache, or fever? Do you have his reports of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and rheumatoid factor available? They are the most important to monitor and diagnose. Did they do any scans of the chest and abdomen? As of now, the reports do not seem very great with high leukocyte count and low Hb.
Hello,Welcome to icliniq.com.I understand your concern.Well, it is a tough spot you are in. It will be difficult for a new rheumatologist to diagnose if you are already on steroids and the symptoms get masked. But I will try to simplify it for you here.
Hello, Welcome to icliniq.com. I have gone through your history and images. (attachment removed to protect patient identity). Your rash seems still very florid and the alopecia is setting in. I am not sure about the medications you are taking as it does not show up on the phone app, but you need to increase your medicines.
Hello, Welcome to icliniq.com. The sort of pain you are describing especially the heel one looks more like enthesitis which is the pain due to tendon inflammation. It can happen at various sites like the buttocks, heels, foot, rib area, lower back, and neck. Since none of your joints are involved, it does not look like rheumatoid arthritis. But considering enthesitis inflammation and your age group, it is always advisable to do inflammatory markers like ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) and get tested for HLA B27 (human leucocyte antigen).
Hello, Welcome to icliniq.com. I understand your concern. You are right in saying that she has the symptoms of Raynaud's with digital gangrene, which is ongoing. Arthritis, there are 50 variants of it, and it is very important to distinguish which one she has, as the management will differ for every type of arthritis. I would like to ask a few more questions: Is there any history of oral ulcers? Hairfall? Any history of fever? Which joints are affected? Is there swelling in the joints? Is there any deformity? Are there any changes in skin color or skin becoming tighter? Is there any history of dry eyes or dry mouth? Is there any muscle weakness that you have observed? With the start of Raynaud's, it seems like a systemic involvement more, something like lupus, but we need to rule it out.
Hello, Welcome to icliniq.com. I would like to ask you a few more queries. Is your sleep pattern normal? Do you have morning fatigue? How long did the viral last? Any hair fall, oral ulcers, dry eyes, or dry mouth? Any recent irritability or forgetfulness? It appears to be chronic fatigue syndrome which usually has a previous viral illness. But let me know these queries and would guide you further. I hope it helps.
Hello, Welcome to icliniq.com. I have gone through your reports (attachment removed to protect patient identity). It seems her arthritis is flaring up again. Eventually, Cyclosporine and HCQs are both very mild when it comes to arthritis management. She may have had a prolonged suppression due to the Rituxan injection.
Hello, Welcome to icliniq.com. I have gone through your history and the blood reports (attachments removed to protect patient identity) along with the photographs you have posted. Well, there is gross swelling in both your legs. However, the albumin levels are not so low that the edema cannot be explained. Even the urine routine is normal.
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