How to get relief from arthritis?

Hello,

Welcome to icliniq.com.

I understand your concern.

I have gone through your attached prescriptions and pathological reports (the attachments were removed to protect the patient's identity), and I think that she has rheumatoid arthritis (not just simple arthritis).

It would be very helpful if you said which joints are involved. Is she stiff in the morning? How long does it take for the stiffness to go away? There are medications for this condition that are gentle on the stomach.

It appears that she is on treatment for osteoporosis and gout at the same time. It would be nice to know if she has an X-ray or DEXA scan for this reason.

Gout is another form of arthritis. Again, I do not see the latest uric acid report. Does she ever have a joint fluid tested for this reason? Did she have attacks where her big joints were involved, like the knee, big toe, and elbow? Yes, I agree that medication can cause stomach pain and gastritis.

The fact that she has anemia makes me think she is losing blood, which is hidden. Like either in her urine or stools. Is her urine tested or stool tested? I would like to see the result and work up for anemia. Please share the results as requested and answer these questions so that I can help you in a better way.

I hope this helps.

Hello,

Welcome back to icliniq.com.

Regarding joint pain, I am leaning more towards her having rheumatoid arthritis (RA). Please obtain a blood test for ANA (antinuclear antibody panel), RF (rheumatoid factor), the latest CBC (complete blood count), LFTs (liver function tests), and U/C/E (urea, creatinine, and electrolytes). I would also like to have an X-ray of her wrist joint. Is her pain bilateral? Although her uric acid is high, she just had one episode of ankle pain and swelling.

I think it was just osteomyelitis (a bacterial infection of bone), not gout. Please provide me with the latest X-ray of her ankle joint. I am strongly inclined to discontinue Allopurinol. Regarding anemia, I would highly suggest that she get an upper GI and lower GI endoscopy; her anemia (low hemoglobin) could be due to her RA or the gastritis she is having due to all the pain medications.

Please get a DEXA scan, as this is the test that will help determine whether she has osteoporosis.

Kindly revert in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

Thank you for following my recommendations.

Discontinue the Allopurinol. Taper it off slowly over two to three weeks. Although her uric acid is 8 mg/dL, it is a little less likely to be gout since her changes on the ankle x-ray are due to an old infection of the bone (osteomyelitis), and it was just one episode. From the DEXA scan, it is evident that she has osteoporosis.

She should not use oral Bisphosphonates like Alendronate. Instead, they should get injectable forms like a yearly infusion of Zoledronic acid (Zomet or Reclast) or three monthly injections of Ibandronate (Boniva). The initial injection may give flu-like symptoms and bone pain, which is a common side effect. It does not cause gastritis or stomach pain like oral medications. She should take 2000 IU of vitamin D and 800-1200 mg of calcium with it. I saw that the EGD was within normal limits but was obtained two years ago.

Were her symptoms still present during that time? Does she have gall bladder surgery done? Please do not take me wrong, but I assumed her pain is in the stomach, which is just below the rib cage in the center. Am I right? If yes, then the Buscopan and Hyoscyamine will not help. They are more for spasms in the large and small intestine. Does she have a history of alcoholism? Why is she on Librax (Chlordiazepoxide)?

Is this for gastritis only? Does it help? If not, please taper it off gradually over the next three weeks. It can cause anemia and constipation, among others. Please do not abruptly discontinue it. For stomach pain I suggest Amoxicillin 1 g twice daily plus Clarithromycin 500 mg twice daily and Rabeprazole or Omeprazole 40 mg twice daily 45 minutes before meals. All three medications are to be taken for 14 days.

Once the 14-day course is over, then continue the Rabeprazole alone for a total of six months at the same dose. You can use Ranitidine 150 mg daily if she still has the stomach pain. Please get an iron profile, anti-CCP (anti-cyclic citrullinated antibody), ESR (erythrocyte sedimentation rate), and an ultrasound of the gallbladder (to look for stones). Given her anemia, she would need a repeat upper GI and lower GI endoscopy to rule out cancer. For her joint pains, use only Tramadol; you can go up to 100 mg three times a day or Paracetamol 1000 mg twice daily.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

Thank you for the kind compliment.

Just two tablets of Paracetamol or Trazodone; both will help if she develops flu-like symptoms. Any calcium supplements like Adcal, one pill twice daily (she should have 1000-1200 mg of calcium). Regarding vitamin D supplements, she can take either 5000 IU once a week or 1000-2000 IU once daily.

I am hoping that she will have a pain-free life.

Kindly revert in case of further queries.

Thank you.

Hello,

Welcome back to icliniq.com.

You did an awesome job of sharing the pictures.

My suspicion was correct, and she has rheumatoid arthritis. I suggest Prednisone 60 mg daily for the first 2 weeks, then reduce to 40 mg for the next 2 weeks, then 10 mg for the next 2 weeks, and then leave her on 5 mg daily.

Consult a specialist doctor, discuss with him or her, and take the medicine with consent. Is it possible for you to take her to a rheumatologist?? She will need relatively advanced treatment for rheumatoid arthritis. For now, let us continue the rest of the medications. She needs them. I am glad that you discontinued those antibiotics.

Regarding the Zolendronic acid, I will give you the information, but I would wait until she is a little more stable. You can still hold onto the information for future reference. Remember, if she has an allergy to any drugs, foods, or other substances, then do not use them. Allergies present as rash, hives, itching, shortness of breath, wheezing, cough, and swelling of the face, lips, tongue, or throat.

Please hydrate her appropriately before the treatment. Paracetamol after administration will reduce the incidence of acute reactions such as joint pain, fever, flu-like symptoms, and muscle pain. The dose recommended is 5 mg once a year; consider discontinuing after 3 to 5 years of use. Nausea is a side effect of Tramadol. Use Motilum 10 mg (Domperidone) on an as-needed basis, up to two times a day. It can make her sleepy, so it's better to be given at bedtime.

I hope this helps.

Thank you.