Dr. Jebin Abraham
Pulmonology (Asthma Doctors)
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,
I am having left side hip pain for the last six months. I am using an elbow crutch while using the staircase, wearing hip support to manage pain. I did magnetic resonance imaging (MRI) two months back, and it showed mild synovitis in the left hip. The doctor suggested a blood test suspecting tuberculosis (TB) in the hip, but that report showed normal. I have attached the MRI and blood test report for reference. I am mentioning my history of tuberculosis below. I underwent six months of TB medication for pulmonary tuberculosis 2.6 years ago. There was blood in my sputum a few times and a low fever before that. The sputum test showed negative but based on the CT scan doctor suspected pulmonary TB. I was recommended medicine (Akurit 4 for two months, Akurit 3 for four months). I gained 3 kg weight, and there was no blood in my sputum during treatment or to date now. I am currently weighing 1 kg more and not having any fever now. This time the doctor told me that synovitis is the initial symptom of bone TB. The blood test will not show these things in the initial stage. He suggested taking TB medicine (Akurit 4 for two months, Akurit 3 for ten months), suspecting bone TB. It has been 52 days since I started taking Akurit 4 this time. The pain has not gone entirely but reduced by 30 percent. I am still using an elbow crutch while using the staircase, wearing hip support, etc. There are some queries, and I need an answer in the above matter. Am I suffering from bone TB? If not, then what can be the cause? Whether the current medicine dosage is acceptable, keeping in view of the earlier TB treatment? Should I do any blood test as it will be two months of taking Akurit 4? How much time will the pain take to disappear after starting TB medicine in case of bone TB? Is there any need to do an MRI again before starting Akurit 3 at the end of two months? Which specialty of doctors, orthopedic or pulmonologist should I consult for this? I am looking forward to your reply. Thank you.
Hi,
Welcome to icliniq.com.
TB (tuberculosis) can recur at any time in any organ after treatment. Bone TB diagnosis is based on a probability basis and not 100 % sure in most cases. You need to try TB medicines and see. Yours is likely a bone TB. But there are several diseases causing synovitis. Since you are an old TB patient, the first doubt is TB. Drugs are the same. But, the dose depends on your weight. Make sure about it. No role for a blood test. Pain generally disappears within three to four months. It depends on the degree of joint involvement. Repeat MRI (magnetic resonance imaging) if your symptoms worsen or we suspect a drug-resistant TB. It is also helpful to document improvement. But in case it is a case of side effects of drugs, drug-resistant TB, consult a pulmonologist. And, next step would be a synovial fluid aspiration and doing GeneXpert for TB diagnosis.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
These are some follow-up queries I have in this regard. Whether the medicines Akurit 4 and Akurit 3 are appropriate for my weight of 136.68 lb? Whether any blood test is required to confirm the side effect of taking TB medicine? How to ensure at this stage if I have a drug-resistant TB? I am a little hesitant to go for magnetic resonance imaging (MRI) due to the pandemic situation now. I am given two options to continue taking Akurit 4 for a few more days or start Akurit 3; which option will be better? There has been a slight reduction in pain up to 25 % to 30 % after starting TB medicines. Does it confirm pain is due to TB, or is there any chance of another disease?
Hi,
Welcome back to icliniq.com.
How many tablets of Akurit 4 are you taking? At what time of the day? And how many minutes are in between each tablet? LFT (liver function test), serum creatinine, serum uric acid, and CBC (complete blood count) are required. Do them monthly. Eye testing for color vision is also needed. At this stage, you do not have to do anything. If you feel it is not improving, then you may require investigation. There is no urgency to take the MRI scan as you are better. Start Akurit 3 after two months. But it should not be stopped after six months as before. The bone TB treatment course is longer. Stop after consultation only. Most likely, it is TB. Even there can be other coexistent diseases like osteoarthritis, which can cause pain. At this stage, it is not wise to think of another condition. You can continue the same treatment; meanwhile, you will experience improvement.
I hope it is clear. Thank you.
Patient's Query
Hi doctor,
Thanks for the reply.
I am taking four tablets of Akurit 4 together in the morning before breakfast. I am also taking a half pill of Benadon 40 at night after dinner. Whether the current dosage of Akurit 4 is acceptable? What should be the dosage of Akurit 3 and Benadon after two months? If the pain is due to osteoarthritis, then can it be cured by tuberculosis (TB) medicine? If not, then what should be the treatment plan for osteoarthritis? Will you suggest any other medicine in this case? I am having a gastritis problem for the last five to six years. The TB medicine that I am taking is causing gastritis daily. I have taken Pentaloc DSR for one month on an empty stomach in the morning before taking TB medicine. However, I regularly find the gastric problem happening again, and I am trying to manage it by taking Pan-D, Eno, etc. Should I take gastric medicine daily before taking TB medicine or whenever it feels like having gastritis in a day? Is it safe to take gastric medicine for months since my TB medication will continue for a long time? Also, is there any natural way to reduce gastritis caused by TB medicine?
I am looking forward to your reply.
Hi,
Welcome back to icliniq.com.
Yes, your current dosage is absolutely fine. Four tablets of Akurit and half a tablet of Benadon are enough. Osteoarthritis pain is not affected by TB medicines. So if your pain improves on TB medicines, it is more or less due to TB only. Osteoarthritis pain is managed by calcium, vitamin D3, cartilage strengthening medicines, exercise, weight reduction, etc., along with painkillers. No other medicines are required. Wait for improvement. Take protein-rich food. Take TB drugs after food, each tablet at five to ten minutes intervals after food intake. Take fruit juices instead of plain water. For example, try putting a tablet inside a banana piece and take it. Avoid spicy food, fried items, sour items, etc. (vinegar, pickle). There are no issues in taking medicines for gastritis. You should continue gastritis tablets.
Thank you.
Patient's Query
Hi doctor,
Thank you so much for the reply.
It has been five months starting medicine for bone tuberculosis (TB). I have taken Akurit 4 for two months and taking Akurit 3 for the last three months. The hip pain is now reduced by 50 % from the beginning but not completely cured. I still get pain when walking a little bit or going on the staircase. I am using a hip belt while walking and an elbow crutch on the staircase. I did MRI after completion of four months and its report is attached. I find the magnetic resonance imaging (MRI) report mentions everything is fine. The gastric problem is acute due to this medicine and my earlier gastric issues. I was taking Pan-D or Pentadoc-DSR on an empty stomach in the morning for a few weeks while taking this medicine. I find gastric goes away in the morning but it again happens in the afternoon or night. I am now having a little cumins seed on an empty stomach in the morning before taking TB medicines. I sometimes also have gastric any time in the day. I try to manage gastric by taking Eno whenever it happens in a day. I take Pan-D at last when gastric does not go away by the above ways. I am drinking warm water after lunch and dinner to avoid gastritis. I have to take Eno roughly every 2 to 3 days intervals. These are some queries I need to be answered.
Looking forward to your reply. Thank you.
Hi,
Happy to see you back here. It is great to know that you have improved much.
Patient's Query
Hi doctor,
Thanks for the reply.
I consulted a family doctor yesterday and he said for bone tuberculosis (TB) only Akurit 4 needs to be taken for one year. He is saying I should have taken only Akurit 4 since this is a re-occurrence of TB and no chance can be taken. He is suggesting I should switch to Akurit 4 for the remaining seven months. These are some queries that I need your help.
Hi,
I understand your concern.
As I already told you, the total duration of treatment for bone TB is one year. The drug Pyrazinamide is needed only for the first 3 months. After 2 months, this drug is removed from treatment. Two-month akurit 4, then 10 months akurit 3. Yes, mainly liver toxicity. Rest you can search in google and get many. This is based on interim treatment guidelines. This needs to be followed all over the country. There is no added advantage to adding Pyrazinamide after 2 months. If you are again in doubt, you can get a third opinion from any other reputed pulmonologist as well.
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Pulmonology (Asthma Doctors)
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