Dr. Suman Saurabh
Orthopedician and Traumatology
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 have been suffering from hip pain for the last nine months. I did an MRI five months ago, which showed mild synovial in my hip. The doctor suspected bone TB and prescribed me medications for it. Four months ago, I had an MRI. The reports were normal. I took the tablet Akurit 4 for two months, and now, I am taking Akurit 3 for three months. I am taking four tablets of Akurit 3 in the morning before breakfast and half a tablet of Benadon 40 at night after dinner. The hip pain is now reduced by 50 % but not completely cured. I still get pain while walking or climbing a staircase. I had pulmonary tuberculosis three years ago and was under medication for six months to get cured. I consulted a doctor yesterday, and he said that tablet Akurit 4 is sufficient for bone TB and suggested I switch to Akurit 4 for the remaining seven months. I would like to know if I should start taking Akurit 4 again as instructed, and is there any problem if I take Akurit 3? What should be the course duration for Akurit 4 and Akurit 3 in bone TB treatment?
Hello,
Welcome to icliniq.com.
I understand your concern.
To monitor the treatment response, you should get an ESR (erythrocyte sedimentation rate) and a CRP (C-reactive protein) test. Repeating an MRI (Magnetic resonance imaging) after four months is unnecessary. Tablet Akurit 4 (Isoniazid 75mg, Rifampicin 150mg, Ethambutol 275mg, and Pyrazinamide 400mg) should be taken for three months, followed by Akurit 3 (Rifampicin 150mg, Isoniazid 75mg, and Ethambutol 275mg). After that, switching on to tablet Akurit 3 is not harmful. I suggest you do ESR and CRP every three months to assess treatment response.
Patient's Query
Hi doctor,
Thank you for the reply.
I did ESR and CRP tests before starting the treatment. I have attached the blood test reports for your reference. These are some follow-up queries in this regard. Firstly, whether ESR and CRP test necessary, and does it confirm bone TB from the MRI? Secondly, how long will it take for the pain to disappear in the hip joint? Finally, how long should I take tablet Akurit-3, and is the current Akurit-4 dose adequate?
Hi,
Welcome back to icliniq.com.
I understand your concern.
The ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are necessary to assess the treatment outcome. And an MRI (Magnetic resonance imaging) report is not confirmatory for TB (Tuberculosis) of the hip. However, it is likely that you developed TB of the hip bone because you had pulmonary TB previously.
Patient's Query
Hi doctor,
Thank you for the reply.
It has been six months since I started medication for bone TB. As suggested, I did all the blood tests, including ESR and CRP. I did the tests after about five and half months after starting medication. Also, along with it, there were some additional blood tests like CBC (complete blood cound) and LFT (liver function tests). The reports are attached here for your reference. I have a few more queries regarding this. Firstly, what do the ESR and CRP values in the report suggest? As well as what the CBC and LFT tests indicate. At times I feel like my head is spinning. I get it when resting and suddenly turning to the opposite side, also when I suddenly get up from bed.
This was the first time I had experienced such problems. Before, I had never had any diabetes or blood pressure issues. Recently I tested my blood sugar levels. It was 71 mg/dL at fasting and 91 mg/dL after food. I also checked my blood pressure, which was 110/80 mmHg. Earlier, I usually had gastritis problems, which are more severe now due to TB medications. I am currently taking ENO and Pan-D to relieve this. When my head spins, I feel bloated. The other queries are: Do I have low blood sugar or blood pressure problems? Can TB medication cause low blood sugar? Is there a need for any medication for the problems mentioned above? Finally, can gastritis cause the head to spin?
Hello,
Welcome back to icliniq.com.
I understand your concern.
I have reviewed the report (attachment removed to protect the patient's identity). The ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are normal. These indicate the activities of the disease.
CBC (complete blood count) and LFT (liver function test) are also normal. They indicate that ATT (Anti-tuberculosis therapy) does not affect your liver. Your blood sugar is slightly lower, so I suggest you take a high sugar and a high protein diet. There is no need for medication, but you can consult a doctor for a second opinion. Gastritis (Inflammation of the lining of the stomach) does not produce head spinning. So, for these symptoms, you should get medical advice.
Patient's Query
Hi doctor,
Thank you for the reply.
It has been ten and half months since I started taking medication for bone TB (tuberculosis). I am taking only four tablets of Akurit-3 in the morning before breakfast and half the tablet of Benadon-40 at night after dinner. However, the pain is not entirely gone, and I still feel pain in the hip. I wear a hip support belt for climbing the staircase and for walking. I use a walking stick while climbing the stairs to avoid pain. I apply Volitra spray, and if the pain is severe, I take a tablet of Ultracet. I have done ESR and CRP tests. The value of ESR and CRP tests are given below. Before starting medicine, the ESR was 12, and CRP was 0.27. Six months after medication, the ESR was 10, and CRP 0.46. Ten months after medication, the ESR was 5, and CRP was 0.26. How much more time will it take for the pain to disappear in the hip joint? How long should I take Akurit-3? What does the value of ESR and CRP suggest? Is there a need for any other diagnosis or change in medication? Should I do any specific exercise for this condition? Is there any problem climbing the staircase in this case?
Welcome back to icliniq.com.
I understand your concern.
It is unlikely that the discomfort will go away completely because TB (Tuberculosis) will cause arthritic changes and stiffness in the hip. As a result, you may occasionally feel it now or later. Yes, this amount is correct, and you will need an MRI (Magnetic resonance imaging) of your hip in two months to assess if the drug is still needed. However, your ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) levels have remained steady throughout the duration. Indicating that there has been no disease progression. It is not currently required because everything appears to be in order. Not right now. You can do it later because it will not affect the outcome. Walking upstairs should be avoided since it strains the hip and can lead to arthritis. However, you can proceed once the MRI is clear.
Patient's Query
Hi doctor,
Thank you for the reply.
I have completed one year of medication for bone TB. When I had pain for 20 days, I used a hip support belt and a walking stick. I have not used a hip belt or a walking stick for the past three days. While walking without support, I experienced some hip soreness, which gradually subsided. Walking or using the stairwell causes just two percent of the discomfort.
I recently did MRI and LFT. The reports are attached for your reference. These are some of my concerns about this issue. Also, I would like to know what the next course of treatment will be. Whether or not to continue the medicine till the pain is gone? What does my MRI report suggest? Can AST and ALT ratios of 1:39 cause any problems? Finally, how to ensure if TB infection has completely gone?
Hello,
Welcome back to icliniq.com.
I understand your concern.
I have reviewed your reports (attachment removed to protect the patient's identity) and would like to say that the disease activity is significantly reduced now. So, firstly, stop the medicine and start some hip and back exercises to gain muscle mobility. The residual pain would remain in some cases. In this case, it is minimal, so there is no need to continue the medicine. MRI (Magnetic resonance imaging) report suggests no disease activity at present. And yes, your LFT (Liver function tests) report is satisfactory. No problem was detected with the ALT (Alanine transaminase) and AST (Aspartate transaminase) ratio. Your ESR (erythrocyte sedimentation rate) and CRP (c-reactive protein) reports were also normal. You are clinically well. At present, your body does not have any disease activity.
Patient's Query
Hi doctor,
Thank you for the reply.
I would like to know a few more things. Is there any chance of re-occurrence of bone TB? Because this is the second time I have been getting a TB infection. The first time I had it, it was in the lungs about three and half years ago. Also, I would like to know what should be done if bone TB happens again. Does taking medicine for about 18 months reduce the chances of re-occurrence of TB?
Hello,
Welcome back to icliniq.com.
I understand your concern.
Yes, tuberculosis (TB) can return. The medication should be restarted with a different treatment if it occurs again. But that is not the case. According to WHO (World Health Organization) standards, tuberculosis medication is sufficient for 12 months if symptoms disappear.
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