Dr. Anshul Varshney
Internal Medicine
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 a 36 year old male. For mild chest pain, I have got my chest x-ray PA view done as suggested by my rheumatologist. My doctor said that x-ray report shows changes of chronic bronchitis in both lungs more in lower zones and old fibrotic scarring is seen in left apex. I am suffering from arthritis for which I am on medication. I have glaucoma. My medication at present for arthritis is Cobix 200 twice daily, HCQS 200 once daily, Pan D before breakfast, Rosuvas once at night, Tryptomer 10 in night, Espidase DP, Folvite 5 mg and Imutrex 15 mg once in a week. Kindly suggest me medication according to the reports attached. Please do not suggest me any other doctor or any hospital as I want to get treated through your medication.
Hi,
Welcome to icliniq.com.
We are here to help you. You are suffering from rheumatoid arthritis and the findings of your chest x-ray (attachment removed to protect patient identity) can be due to the following reasons such as Smoking, allergy, rheumatoid related interstitial lung disease (ILD), and Methotrexate lung. The treatment would be based on the symptoms that you might be getting. I would advice in such case to first get a HRCT chest (high resolution CT scan) along with sputum for AFB (acid-fast bacilli) done, which would rule out the evidence of tuberculosis. Rest for rheumatoid arthritis, your treatment is going in right direction. Further treatment decision would be based on CT chest.
The Probable causes
Investigations to be done
Preventive measures
Patient's Query
Hi doctor,
Thank you for your guidance. As suggested by you, we have performed sputum for AFB test. Result states no acid fast bacilli seen. Please find the report attached for sputum. I have still not conducted the HRCT chest as this scan is expensive for me. Request you to kindly suggest me medication for the chronic bronchitis to be treated for which I had attached chest x-ray report rather than CT. My weight is 64 kg. What do you mean by Methotrexate lung?
Hi,
Welcome back to icliniq.com.
People suffering from rheumatoid arthritis can have associated interstitial lung disease. Even one can develop Methotrexate lung following long-term use of the Methotrexate drug, as you have been taking once weekly. I would like to know the symptoms that you are feeling related to lung issues. So, treatment would be based on that. As far as remaining treatment is concerned you need to carry on the same. I would recommend you to see a senior physician in your area or a rheumatologist for the same.
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Internal Medicine
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