Dr. Naval Mendiratta
Rheumatology
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Patient's Query
Hello doctor,
RA patient for 13 years and on treatment with Methotrexate, Leflunomide. Then suffered from aplastic anemia and ATG treatment done with partial recovery. Presently on Cyclosporine on the advice of hematologist and HCQS on advice of Rheumatologist. Reti iman chemotherapy was done since then 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 hip, knee, shoulder, and neck, etc., feels lethargic early morning, finger joints are swollen with severe pain. Taking Aceclofenac100 with Paracetamol 325 almost daily, if the pain is less she takes Paracetamol 650. Please advise medication during lockdown.
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 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 minimum pain killers. As they are not a wise option when aplastic anemia is in the background.
I hope this helps.
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