Dr. Naval Mendiratta
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
Hello doctor,
My 21-year-old daughter suffered from severe abdominal pain and vomiting one month back. I consulted a local physician for treatment. He gave some antibiotics, but no relief. I consulted a gastrologist too. He prescribed some medicines, but no relief. He advised me to do the abdominal sonography; no abnormality was found. I consulted Rheumatologist, and she was diagnosed with PAN. The doctor advised doing a CT angiogram. The CT angiogram showed multiple aneurysms. The previous CT has done eight years back. She is currently taking Predace, Azoran 50 mg, Telma 40 bd, Stamlo 5 mg twice a day, and Cizaspa-X.
Hello,
Welcome to icliniq.com.
I have gone through your query. The diagnosis of Polyarteritis nodosa looks quite certain. Microaneurysms, high blood pressure, and high CRP are favoring it as well. I understood that she had been started on steroids and Azoran (Azathioprine). My personal recommendation would be to go for Cyclophosphamide as it can shut off the disease quickly and decrease the incidence of relapses.
I hope this helps.
Patient's Query
Hello doctor,
Thank you for the response.
My treating doctor believes that we should wait for the effect of steroids and the tablet Azoran as the side effect of Cyclophosphamide is too much. Is he right? How much time do tablet Azoran and steroids take to show their effects?
Hello,
Welcome back to icliniq.com.
Steroids are usually quick and act within two to three weeks, whereas tablet Azoran takes around four to six weeks to start acting. As such, there are not many side effects with Cyclophosphamide. It can be a difference of opinion, but overall results have been better with Cyclophosphamide for induction therapy. I suggest you start with these two drugs, provided her symptoms are in check, or switch to Cyclophosphamide if needed.
I hope this helps.
Thank you.
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Rheumatology
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