Dr. Srivastava Durgesh
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My daughter, aged 21 years, was diagnosed with PAN 11 years ago. And she was treated with Omnacortil, Azoran, and Cyclophosphamide. After four years of treatment, the disease went into remission, and since then, she has been drug-free. However, three years ago, she complained about severe abdominal pain, and the rheumatologist started her on a steroid and Azoran, but with no relief. And she got perforation of the intestine after a few months of the medication. So the repair surgery was done, and now she has been discharged from the hospital, though the wound has not healed completely. And during this treatment, she was tested for DADA 2 and was found positive for it. So now the doctors are planning for biological HUMIRA. But the dilemma is whether it should be given now or should we wait for the wound healing? Also, her recent laboratory reports showed ESR 35 mm/hr and CRP 1.5 mg/L.
Please advise.
Hi,
Welcome to icliniq.com.
I went through your query and understood your concern. If the abdominal pain is relieved with oral medications, I would prefer to wait until the wound is healed. Sometimes, healing may be delayed by biological medications like Adalimumab (monoclonal antibody). In addition, I would like to know what were her presenting symptoms 11 years ago. Kindly follow up with the answer.
Thank you.
Patient's Query
Hi doctor,
I have attached the discharge summary for your reference. Currently, she is on Wysolone 7.5 mg. Should we increase the dose, or should we give her any other medication? But the pain is tolerable. In addition, we are also giving her a Buscopan tablet for it.
Hi,
Welcome back to icliniq.com.
I have seen the discharge summary (attachment removed to protect the patient's identity). Increasing Wysolone (Corticosteroid) will also delay wound healing. So it is better to wait for a few more days and then start anti-TNF (tumor necrosis factor).
I hope that she gets well soon.
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Rheumatology
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