What medicines help reduce my mother’s inflammation and pain?

Question

Hi doctor,

Five years ago, my mother was diagnosed with fibromyalgia. I think she also has rheumatoid arthritis. For the past five years, she was managing the pain with anti-inflammatory medicine, Lyrica, Mythycobal, Voltaren injections, herbal creams, etc.

You can see the veins in her hands popping out. I also realized that the pain has gotten worse now. For about 12 months, the doctor put her on Prednisolone 5 mg per day and a painkiller when necessary. She was fine till last month, but the pain in her hands has increased now. In the daytime, she is fine, and the pain starts mildly in the evening. When she lies down in bed, she gets electrical tingling in her legs, which disturbs her sleep.

She underwent several tests last week, and I attached them for your reference. She has not consulted a rheumatologist yet. What medication can I give to reduce the inflammation and cure her? Her ESR, CPR, and ANA are quite high. The pain in her hands and the tingling in her legs at night are agonizing her life. Kindly provide your expert advice.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

First of all, your mother does not have rheumatoid arthritis or fibromyalgia. From her reports (attachment removed to protect patient identity), I found that she has connective tissue disorder, and the most likely diagnosis would be systemic lupus erythematosus (SLE).

The joint pain, high ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), positive ANA (antinuclear antibody), and response to Prednisolone favor the diagnosis of connective tissue disorder. She definitely does not have functional pain, which occurs in fibromyalgia. Her pain and suffering are very real.

Now, to help you better, I need some more details:

How long has she suffering from all these?
Is there any frequent reddening of the eyes?
Does she suffer from oral ulcers or any rash over the nose or cheek after sun exposure?
Did she have any past history of heart and lung issues?

I would also like to know if her anti-ds DNA (anti-double-stranded DNA) test has been performed.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Please check her anti-DS DNA test in a short period, and the laboratories that perform ANA may also perform anti-DS DNA. She needs Prednisolone for disease activity control. Though it has various side effects, it is essential. She should also be started on Hydroxychloroquine sulfate (HCQS).

This drug helps in the long term. Now, for acute pain, she would require an anti-inflammatory painkiller like Etoricoxib. During the winter or during the acute painful attacks, she might require treatment with a single shot of intramuscular Methylprednisolone that gives pain relief for two to three weeks. So, in short, she needs steroids at present.

In fact, at big centers, we also use monoclonal antibodies like Rituximab, which is costly but helps a lot in controlling the disease activity. So at present, she should see a doctor, an internal medicine specialist (MD in medicine), and share my opinion.

I hope this helps.

Please revert in case of further queries.

Thank you.