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Erythrocyte Sedimentation Rate Is 57 And CRP Is 24. Is It Safe To Take Saaz500, Microcid 25 And Depomedrol 160?
Question: my erythrocyte sedimentation rate is 57 and CRP is 24.
My doc has suggested me to take
SAAZ 500
microcid 25
and
depomedrol 160 mg
i was just worried if they are steriods and shd i take them.
what could be the side effects.
thanks
My doc has suggested me to take
SAAZ 500
microcid 25
and
depomedrol 160 mg
i was just worried if they are steriods and shd i take them.
what could be the side effects.
thanks
Dear XXXXXXX,
Before I answer your question I would like to know a few more details about your health.
- What were your symptoms when your doctor decided to go for testing ESR and CRP?
- Did your doctor check for TSH, Sugars, haemoglobin etc as a general measure before deciding to start you on these medications?
The medications SAAZ and Microcid are not a steroid but are pain-killers not to be used for longer time in a person of your age.
The medication Depomedrol is certainly a steroid.
Unless your symptoms and investigations are certain that you have arthritis of autoimmune origin or due to something that cannot be treated otherwise, no doctor would directly start you on these medications directly.
So my request is to give details about your symptoms- what symptoms, when did they start, what worsens them, what alleviate the symptoms etc. And provide the other investigation reports if they have been done. Then I can definitely tell you whether you need these medications or not, whether you should take them or not. If there is anything else you can do to treat yourself.
Let me know what I have asked you for. Take care.
Before I answer your question I would like to know a few more details about your health.
- What were your symptoms when your doctor decided to go for testing ESR and CRP?
- Did your doctor check for TSH, Sugars, haemoglobin etc as a general measure before deciding to start you on these medications?
The medications SAAZ and Microcid are not a steroid but are pain-killers not to be used for longer time in a person of your age.
The medication Depomedrol is certainly a steroid.
Unless your symptoms and investigations are certain that you have arthritis of autoimmune origin or due to something that cannot be treated otherwise, no doctor would directly start you on these medications directly.
So my request is to give details about your symptoms- what symptoms, when did they start, what worsens them, what alleviate the symptoms etc. And provide the other investigation reports if they have been done. Then I can definitely tell you whether you need these medications or not, whether you should take them or not. If there is anything else you can do to treat yourself.
Let me know what I have asked you for. Take care.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Hi,
(All reports are enclosed)
The problem started around 3 years ago with a stretching pain at both side of the lower back.
That time MRI spine was done but everything was fine.
Then after an year or so neck pain started and I never took that seriously.
later in XXXXXXX 2012 neck pain increased a lot.
In the month of April 2012 the MRI CERVICAL SPINE WITH SCREENING OF WHOLE SPINE was done and report is enclosed. It shows some bone marrow edema.
and suggested HLA-B27 and bone scan
HLA-B27 was negative and bone scan was fine as well (reports are enclosed)
and I got all the basic blood tests done:
cholesterol and alkaline phosphate were a bit high and vitamin D a bit low. uric acid and RF were fine.
So I took 4 shots of vitamin D injection
finally 3 months ago both knees started to pain with more in left and very less in right knee.
MRI left knee was done and it also says bone marrow edema and rest all fine.
The orthopedision suggested me to take shellcal and glucosamine sulphate for 1 month
but the pain didn’t reduce
The I went to a rheumatologist and he did the following test:
CREATININE
SGPT
CPK
ESR
CRP
and both ESR and CRP were high.
he said it’s a kind of arthritis more likely ankelosing spondylits. and suggested me to take:
SAAZ 500
microcid 25
and
depomedrol 160 mg
He said if I have medical insurance then I can also go for Remicade that too after some tests being done. I didn’t take any of these medications
Finally I visited another rheumatologist and he suggested me nu for 10 days and asked me to come back. As he said it looks like a kind of inflammation disease and if the inflammation reduces with this tab we can conclude it’s a kind of arthritis.
Now after taking I feel 50 % better but not completely.
I have started basic yoga and evening walk post dinner as well.
Now my questions are:
1. what kind of arthritis I have if I have as HLA-B27 and RF are negative. And which medication should I take and for how long do I need to take that. moreover should I go for Remicade as I read many side effects of it.
2. is the disease curable.
3. should I see a gastroenterologist as well
4. I am planning to hit a gym would that be a good idea.
(All reports are enclosed)
The problem started around 3 years ago with a stretching pain at both side of the lower back.
That time MRI spine was done but everything was fine.
Then after an year or so neck pain started and I never took that seriously.
later in XXXXXXX 2012 neck pain increased a lot.
In the month of April 2012 the MRI CERVICAL SPINE WITH SCREENING OF WHOLE SPINE was done and report is enclosed. It shows some bone marrow edema.
and suggested HLA-B27 and bone scan
HLA-B27 was negative and bone scan was fine as well (reports are enclosed)
and I got all the basic blood tests done:
cholesterol and alkaline phosphate were a bit high and vitamin D a bit low. uric acid and RF were fine.
So I took 4 shots of vitamin D injection
finally 3 months ago both knees started to pain with more in left and very less in right knee.
MRI left knee was done and it also says bone marrow edema and rest all fine.
The orthopedision suggested me to take shellcal and glucosamine sulphate for 1 month
but the pain didn’t reduce
The I went to a rheumatologist and he did the following test:
CREATININE
SGPT
CPK
ESR
CRP
and both ESR and CRP were high.
he said it’s a kind of arthritis more likely ankelosing spondylits. and suggested me to take:
SAAZ 500
microcid 25
and
depomedrol 160 mg
He said if I have medical insurance then I can also go for Remicade that too after some tests being done. I didn’t take any of these medications
Finally I visited another rheumatologist and he suggested me nu for 10 days and asked me to come back. As he said it looks like a kind of inflammation disease and if the inflammation reduces with this tab we can conclude it’s a kind of arthritis.
Now after taking I feel 50 % better but not completely.
I have started basic yoga and evening walk post dinner as well.
Now my questions are:
1. what kind of arthritis I have if I have as HLA-B27 and RF are negative. And which medication should I take and for how long do I need to take that. moreover should I go for Remicade as I read many side effects of it.
2. is the disease curable.
3. should I see a gastroenterologist as well
4. I am planning to hit a gym would that be a good idea.
Dear XXXXXXX,
Thanks for sending your reports. I was able to view the reports sent. It indicates swelling of bone marrow due to inflammation of 'unknown origin'. As a general physician I would feel to repeat the ESR after another month or so and see if it is on the rise, falling down or just the same (50 to 60). If it is rising, then we can do simple tests to rule out infections e.g. bone tuberculosis which is treatable conditions.
Keep watch on your weight if it is going down without any reason and if your appetite is fine or reducing. In case of bone tuberculosis, you might not have very obvious symptoms of fever and weakness. Your ALP was high due to low Vit D and it is good that you have already taken the vitamin D shots. I would still suggest you to take maintenance dose of Vitamin D orally- over the counter preparation like 'Calcitrol sachet' once a month - that will keep the Vit D levels sufficient.
1. Your arthritis cannot be diagnosed at this stage. We can name it just 'arthritis of unknown origin'. If your doctor has named it as 'ankylosing spondylitis', it can be probably due to low vit D. Let us wait for a few weeks. If your are less symptomatic now, take anti-inflammatory medication like 'COMBIFLAM' tablet as and when the pain or swelling is too much. It is available over the counter. If tablet 'NU' is nimesulide, please be informed that it is a banned medication in view of liver injury etc. So I would say, try plain paracetamol tablet- CROCIN 500 mg whenever required or else Combiflam when the pain is too much. For sure, no need of the steroid shots. You may avoid it if you haven't taken them yet.
If you are recovering with NU kind of anti-inflammatory agents then no need of Remicade at this stage. You can still try to wait and watch if your symptoms go down with healthy lifestyle as you have planned and by watching your ESR. If things fall in place then you can stop medications.
2. The arthritis if is due to treatable condition like bone tuberculosis, it is certainly curable. If not, certainly controllable with appropriate medications and healthy lifestyle.
3. There is no indication for you to see a gastroenterologist from what you have cited and posted in your lab tests.
4. Going to gym, all of sudden can burden your joints. So go slow, very slow, to start with. I would suggest try moderate walks and upper body exercises. You can try gym once you are totally alright. Yoga will do good.
Finally, I have not seen your thyroid test report here, i.e. TSH report. If it was not done, please get it done when you repeat your ESR test. With a history of joint pain and swelling since more than a year and without seeing you personally, hard to recommend this test strongly, but still as a part of basic work up for joint swelling, one needs to do this test for sure. It is not very expensive test at all.
Hope this helps you to understand. Let me know if you have any other concern.
Wish you speedy recovery...
All the best!
Thanks for sending your reports. I was able to view the reports sent. It indicates swelling of bone marrow due to inflammation of 'unknown origin'. As a general physician I would feel to repeat the ESR after another month or so and see if it is on the rise, falling down or just the same (50 to 60). If it is rising, then we can do simple tests to rule out infections e.g. bone tuberculosis which is treatable conditions.
Keep watch on your weight if it is going down without any reason and if your appetite is fine or reducing. In case of bone tuberculosis, you might not have very obvious symptoms of fever and weakness. Your ALP was high due to low Vit D and it is good that you have already taken the vitamin D shots. I would still suggest you to take maintenance dose of Vitamin D orally- over the counter preparation like 'Calcitrol sachet' once a month - that will keep the Vit D levels sufficient.
1. Your arthritis cannot be diagnosed at this stage. We can name it just 'arthritis of unknown origin'. If your doctor has named it as 'ankylosing spondylitis', it can be probably due to low vit D. Let us wait for a few weeks. If your are less symptomatic now, take anti-inflammatory medication like 'COMBIFLAM' tablet as and when the pain or swelling is too much. It is available over the counter. If tablet 'NU' is nimesulide, please be informed that it is a banned medication in view of liver injury etc. So I would say, try plain paracetamol tablet- CROCIN 500 mg whenever required or else Combiflam when the pain is too much. For sure, no need of the steroid shots. You may avoid it if you haven't taken them yet.
If you are recovering with NU kind of anti-inflammatory agents then no need of Remicade at this stage. You can still try to wait and watch if your symptoms go down with healthy lifestyle as you have planned and by watching your ESR. If things fall in place then you can stop medications.
2. The arthritis if is due to treatable condition like bone tuberculosis, it is certainly curable. If not, certainly controllable with appropriate medications and healthy lifestyle.
3. There is no indication for you to see a gastroenterologist from what you have cited and posted in your lab tests.
4. Going to gym, all of sudden can burden your joints. So go slow, very slow, to start with. I would suggest try moderate walks and upper body exercises. You can try gym once you are totally alright. Yoga will do good.
Finally, I have not seen your thyroid test report here, i.e. TSH report. If it was not done, please get it done when you repeat your ESR test. With a history of joint pain and swelling since more than a year and without seeing you personally, hard to recommend this test strongly, but still as a part of basic work up for joint swelling, one needs to do this test for sure. It is not very expensive test at all.
Hope this helps you to understand. Let me know if you have any other concern.
Wish you speedy recovery...
All the best!
Above answer was peer-reviewed by :
Dr. Prasad
Thank you a lot for replying.
1. I have changed my lifestyle and the diet completely now.
I work in morning shifts 5:30 am to 2:30 pm. I get up by 5 am have 2 pieces of raw garlic along with half a table spoon of a mixture of turmeric + dry ginger powder + methi seeds powder with around 1 liters of XXXXXXX warm water.
Then before leaving I will have 5 to 7 soaked almonds and a bowl of curd or half an XXXXXXX
I will have breakfast around 8:30 am and that too muesli with fruits + egg whites.
I will have 2 cup of XXXXXXX tea between breakfast and lunch.
During lunch I have loads of salad and 2 chapattis with veg.
Will have fruits in the evening and another cup of XXXXXXX tea.
During dinner I will have 2 or 3 chapattis with dal without tadka (at time with very little ghee)
Before sleeping I will have the mixture again and a glass full of hot milk with turmeric mixed in it.
I try to have around 4 to 5 liters of water during the day.
Moreover I have started some basic yoga exercises daily and evening walk.
In case the office timings are affecting my health I have get that changed as well to 9 am to 6 pm.
2. My weight is constant in fact the tummy has increased a few inches. The appetite is fine as well. I will take the 'Calcitrol sachet' once a month from now onwards.
The tablet I am having is nucoxia 90. (Sorry I forgot to put the name last time)
3. Finally I am planning to get the below tests repeated by 15th of this month.
ESR
CRP
Vitamin D
ALP
Cholesterol
4. I am very scared and tensed about the disease I have. Just at the age of 31 I have such problem. I got married in the month of October 2011 and was planning for a baby.
So what affect this disease is going to make on my family planning. Should I plan now or later?
I use to be very active, till the month of XXXXXXX or Feb. 2012 I use go for jogging at times and didn’t have any issues. Moreover in XXXXXXX and July I use to play table tennis and was fine. The only reason I stopped playing was the knee pain. So just want to know why I have such a problem which is clearly related to inactive life style.
5. Do I need to get any tests done for my liver functionality?
1. I have changed my lifestyle and the diet completely now.
I work in morning shifts 5:30 am to 2:30 pm. I get up by 5 am have 2 pieces of raw garlic along with half a table spoon of a mixture of turmeric + dry ginger powder + methi seeds powder with around 1 liters of XXXXXXX warm water.
Then before leaving I will have 5 to 7 soaked almonds and a bowl of curd or half an XXXXXXX
I will have breakfast around 8:30 am and that too muesli with fruits + egg whites.
I will have 2 cup of XXXXXXX tea between breakfast and lunch.
During lunch I have loads of salad and 2 chapattis with veg.
Will have fruits in the evening and another cup of XXXXXXX tea.
During dinner I will have 2 or 3 chapattis with dal without tadka (at time with very little ghee)
Before sleeping I will have the mixture again and a glass full of hot milk with turmeric mixed in it.
I try to have around 4 to 5 liters of water during the day.
Moreover I have started some basic yoga exercises daily and evening walk.
In case the office timings are affecting my health I have get that changed as well to 9 am to 6 pm.
2. My weight is constant in fact the tummy has increased a few inches. The appetite is fine as well. I will take the 'Calcitrol sachet' once a month from now onwards.
The tablet I am having is nucoxia 90. (Sorry I forgot to put the name last time)
3. Finally I am planning to get the below tests repeated by 15th of this month.
ESR
CRP
Vitamin D
ALP
Cholesterol
4. I am very scared and tensed about the disease I have. Just at the age of 31 I have such problem. I got married in the month of October 2011 and was planning for a baby.
So what affect this disease is going to make on my family planning. Should I plan now or later?
I use to be very active, till the month of XXXXXXX or Feb. 2012 I use go for jogging at times and didn’t have any issues. Moreover in XXXXXXX and July I use to play table tennis and was fine. The only reason I stopped playing was the knee pain. So just want to know why I have such a problem which is clearly related to inactive life style.
5. Do I need to get any tests done for my liver functionality?
XXXXXXX,
I think you wait for a few more weeks. Good that you are not on Nimesulide. Whatever the other doctor has prescribed for you (etoricoxib) seems alright.
Repeat only ESR and TSH tests. Checking cholesterol, vit D, CRP and ALP is waste of time, money and resources. Vit D would be fine, ALP will also return to normal, CRP is very non-specific test and you have bad cholesterol (LDL) which is really high. If you have family history of heart disease then only you need treatment for that, else you can control the LDL part with your healthy lifestyle what you have started now- it is excellent- please do not give up and stick to it. So you can repeat Lipid profile test(total cholesterol, LDL, HDL, Triglycerides) only after 3 months from where you have started these lifestyle changes.
As you were not on Nimesulide, you do not need to check liver function tests.
1. Your lifestyle seems great as of now, so no need to change the work timings unless you want it.
2. Weight has to be watched. No rise/ fall should be allowed if the weight is right for your height. Your average blood sugar (HbA1c) is 5.9% and that warrants you to continue efforts of exercise and diet what you have already started to avoid future risk of diabetes. And unexplained weight loss should warrant you to check with a physician promptly.
3. I answered which tests are not needed to be repeated now.
4. You do not have anything major and please feel confident. You can very much plan for baby. Do not be scared. Your constant watch on your health will help you either get the symptoms disappear permanently or at least lead a good physician/ rheumatologist to reach diagnosis and treat you properly. Apparently there is nothing so serious from the tests that you should be worried so much. Please be patient.
5. I told you, no need of LFTs as of now.
Wish you all the best. Do let me know about your TSH and ESR and stay happy.
I think you wait for a few more weeks. Good that you are not on Nimesulide. Whatever the other doctor has prescribed for you (etoricoxib) seems alright.
Repeat only ESR and TSH tests. Checking cholesterol, vit D, CRP and ALP is waste of time, money and resources. Vit D would be fine, ALP will also return to normal, CRP is very non-specific test and you have bad cholesterol (LDL) which is really high. If you have family history of heart disease then only you need treatment for that, else you can control the LDL part with your healthy lifestyle what you have started now- it is excellent- please do not give up and stick to it. So you can repeat Lipid profile test(total cholesterol, LDL, HDL, Triglycerides) only after 3 months from where you have started these lifestyle changes.
As you were not on Nimesulide, you do not need to check liver function tests.
1. Your lifestyle seems great as of now, so no need to change the work timings unless you want it.
2. Weight has to be watched. No rise/ fall should be allowed if the weight is right for your height. Your average blood sugar (HbA1c) is 5.9% and that warrants you to continue efforts of exercise and diet what you have already started to avoid future risk of diabetes. And unexplained weight loss should warrant you to check with a physician promptly.
3. I answered which tests are not needed to be repeated now.
4. You do not have anything major and please feel confident. You can very much plan for baby. Do not be scared. Your constant watch on your health will help you either get the symptoms disappear permanently or at least lead a good physician/ rheumatologist to reach diagnosis and treat you properly. Apparently there is nothing so serious from the tests that you should be worried so much. Please be patient.
5. I told you, no need of LFTs as of now.
Wish you all the best. Do let me know about your TSH and ESR and stay happy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply mam.
Today I visited a XXXXXXX Rheumatologist and he says I have symptoms of the disease SAPHO syndrome
as I have bone edema, joint inflammation and acne.
I forgot to tell one thing that I have acne in my head, back, chest and recently a lot on face (these came after I took glucosamine sulphate)
the acne comes and goes away after some time, not constant.
He referred me to the dermatologist but the skin doctor confirmed these acne are not symptoms of SAPHO.
Finally the rheumatologist prescribed me:
nucoxia 90 for 1 month
sazo 500
1 daily for 5 days
2 daily for next 5 days
3 daily for next 5 days
saaz DS
2 daily for next 15 days
and repeat
CBC
ESR
SGPT
SGOT
if still things don’t work
zoledronic acid
or
pamidronic acid
Today I visited a XXXXXXX Rheumatologist and he says I have symptoms of the disease SAPHO syndrome
as I have bone edema, joint inflammation and acne.
I forgot to tell one thing that I have acne in my head, back, chest and recently a lot on face (these came after I took glucosamine sulphate)
the acne comes and goes away after some time, not constant.
He referred me to the dermatologist but the skin doctor confirmed these acne are not symptoms of SAPHO.
Finally the rheumatologist prescribed me:
nucoxia 90 for 1 month
sazo 500
1 daily for 5 days
2 daily for next 5 days
3 daily for next 5 days
saaz DS
2 daily for next 15 days
and repeat
CBC
ESR
SGPT
SGOT
if still things don’t work
zoledronic acid
or
pamidronic acid
Dear XXXXXXX,
Yes, acne are quite common in SAPHO. But unless they are infected and troublesome, they do not need treatment. You will do good with the anti-inflammatory agents your doctor has prescribed for you. And as he correctly said, if these medications do not work, he should try some antibiotics acting even on your bones with the zolendronate or palmidronate.
Anyway, now please follow this doctor even though your dermatologist refuses to confirm the diagnosis of SAPHO for the acne. See the effect and taking anti-inflammatory which are non-steroidal are not hazard.
Take care. Do repeat the tests he's adviced you to do.
All the best.
Yes, acne are quite common in SAPHO. But unless they are infected and troublesome, they do not need treatment. You will do good with the anti-inflammatory agents your doctor has prescribed for you. And as he correctly said, if these medications do not work, he should try some antibiotics acting even on your bones with the zolendronate or palmidronate.
Anyway, now please follow this doctor even though your dermatologist refuses to confirm the diagnosis of SAPHO for the acne. See the effect and taking anti-inflammatory which are non-steroidal are not hazard.
Take care. Do repeat the tests he's adviced you to do.
All the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Alright mam thanks for the help and support.
Will update you my health status after 1 month.
Thanks a lot again !!!!!!
Will update you my health status after 1 month.
Thanks a lot again !!!!!!
You are welcome, XXXXXXX. Wish you all the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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