How can the RA pain be managed after chemotherapy?

Question

Hello doctor,

RA patient for 13 years and on treatment with Methotrexate and Leflunomide. Then, they suffered from aplastic anemia, and ATG treatment was done with partial recovery. They are presently on Cyclosporine on the advice of a hematologist and HCQS on the advice of a Rheumatologist. Reti Iman's chemotherapy was done since then, and RA was in remission until January 2020.

Lab reports show:

Creatinine - 1.0

Urea - 39.

Uric acid - 4.59.

Hemoglobin - 9.7.

TLC - 3.26.

Platelets -168.0.

Now the patient is having typical attacks of RA in various joints like the hip, knee, shoulder, and neck, feels lethargic early morning, and finger joints are swollen with severe pain. Taking Aceclofenac 100 with Paracetamol 325 almost daily, if the pain is less, she takes Paracetamol 650. Please advise on medication during lockdown.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your reports (attachment removed to protect patient identity). It seems her arthritis is flaring up again. Eventually, Cyclosporine and HCQs are both very mild when it comes to arthritis management. She may have had a prolonged suppression due to the Rituxan injection. At this stage, my suggestion would be to restart Leflunomide. As the TLC (total leukocyte count) count is still low, Methotrexate may not be the best choice. Secondly, she can take injection Kenacort 80 mg (Triamcinolone) intramuscular once a week for two weeks. It will settle the inflammation fast. Thirdly, use minimal painkillers. As they are not a wise option when aplastic anemia is in the background.

I hope this helps.