Hi I Need A Rheumatologist . I Was On Xeljanz,

Posted on Sun, 24 May 2020

Question: Hi I need a rheumatologist.

I was on Xeljanz, but had to get back to Methotrxate and Prednisone until I get back to XXXXXXX

My finger in my left hand is swelling despite the medication.

What to do?

M

Follow up: Dr. Naval Mendiratta (0 minute later)

Hi I need a rheumatologist.

I was on Xeljanz, but had to get back to Methotrxate and Prednisone until I get back to XXXXXXX

My finger in my left hand is swelling despite the medication.

What to do?

M

Answered by Dr. Naval Mendiratta (3 hours later)

Brief Answer:
Rheumatoid arthritis

Detailed Answer:
Respected sir

thank you for writing on health care magic

I understand your disease may be flaring since Xeljanx has gone off. Although good drug but due to short half life disease bounces back immediately when you stop.

1. what is the dose of methotrexate and prednisone you are taking

2. Which location are you based in currently?Will see how we can procure medications there

3. Any other joint swellings apart from.fingers

Methotrexate has a slow action, so it will take 3 to 4 weeks to get back on course.We can adjust the prednisone dose for now till u manage to restart xeljanz again

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Naval Mendiratta (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Naval Mendiratta (28 minutes later)

Dear Dr.Mendiratta

I have had PsA for 12 years.
I started on Metx and folic acid after 2 weeks of Predisone in 2008.

Since then I have had these prescriptions until 2018 when I started on Xeljanz oral tablets. 11mg in Califronia.

The Xeljanz dose was 11mg, but it's so strong and effective that my XXXXXXX doctor in California told me to take one tablet every other day. So I was able to save tablets. My medical insurance sends me a bottle monthly.

When I arrived in XXXXXXX Lanka in XXXXXXX 2019 my brother would send me the Xeljanz tablets every month from California. My medical insurance. unfortunately stopped sending me tablets after August 2019 because they require a doctor visit every six months. But my stock lasted until January 2020.

I was able to order from XXXXXXX Xeljanz for $300, but the dose they had was only 5mg, but it worked fairly well. I took one tablet every day.

I stopped Xeljanz when I arrived in Bali in March 2020. My XXXXXXX stock ran out. So a Balinese rheumatologist put me on MTX. 2.5 mg a tablet with folic acid and vitamin D. I also bought Prednisone in XXXXXXX Lanka and took some until last week. I still have some, but I'm not sure the dose. They come ten a packet.

But the swelling in my left ring finger is very bad now. It's stiff and it's hard to move. My small toe on my right foot is beginning to bother me, too.

I am stranded in Bali in a luxury hotel because all international flights are cancelled due to the virus. Maybe in XXXXXXX I can fly back to California and get free Xeljanz again at 11mg when I see my doctor again. This stuff really works.

Xeljanz is not available in Bali.

I'm worried because the virus is spreading in Bali and my existing conditions could make me more vulnerable.
XXXXXXX

Follow up: Dr. Naval Mendiratta (0 minute later)

Answered by Dr. Naval Mendiratta (1 hour later)

Brief Answer:
Further Course

Detailed Answer:
Thanks for the reply

Oh that s tough situation to be in for you. Swelling looks like a relapse of the disease only

1. only concern is prednisone which lowers immunity..Hence we will have to be careful on continuing it for long ..But for now u can take at 10 mg daily for 7 days and then reduce to 7.5 daily for 10 days and then 5 mg

2. Methotrexate dose has to be better. It should be least 15 mg a week to 20 mg. Only then it will show some effect

3. For reducing pain you can try with celecoxib or etoricoxib for 7 to 10 days.

Guess will have to wait for these medicines to show some effect.Could have arranged Xeljanz from XXXXXXX if u were anywhere around.Would be tough to send it across there

Do let me know for more queries

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Naval Mendiratta (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (2 hours later)

Dear Dr. Mendiratta

I'm confused about the prednisone dose.

The packets I bought in XXXXXXX Lanka are ten tablets each, but I don't know how many mg each tablet has. I have been taking one tablet a day, but I think the dosage is too low.

I definitely have not been taking enough Metax dosage so I will ramp it up along with folic acid. Vitamin D too?

I have never heard of celecoxib. How much dosage of this medication?

The pain in my swollen ring finger is bad and my wrists are hurting a bit.

Are you located in India?
XXXXXXX

Follow up: Dr. Naval Mendiratta (0 minute later)

Answered by Dr. Naval Mendiratta (34 minutes later)

Brief Answer:
Further Course

Detailed Answer:
Dear XXXXXXX

Yeah, I am based in XXXXXXX

Well Prednisone can vary from country to country. Usually in XXXXXXX the dose is 5 mg, 10 mg, 20 and 40. So you will have to check the dosing to be sure. Maybe put it online on google and check the current dose.

Celecoxib is just a pain killer/anti-inflammatory which is very common in US for the pain relief. The dose is 200 mg twice daily. Or Etoricoxib 90 mg once daily. They will help improve the pain and inflammation till Folitrax takes its course.

Regards
Dr NAval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Naval Mendiratta (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (26 minutes later)

Dear Dr. Mendiratta

I have been to XXXXXXX three times.

A trip to XXXXXXX was cancelled because of the virus.

I don't know what dosage I got in XXXXXXX Lanka. The ten tablets in the packet could be anything.

I do know that if I take one tablet it doesn't have much of an effect. Maybe take 2 tablets. I'm always worried when I take steroids.
XXXXXXX

Follow up: Dr. Naval Mendiratta (0 minute later)

Answered by Dr. Naval Mendiratta (26 minutes later)

Brief Answer:
Steroid dosing

Detailed Answer:
Yeah I understand..In this covid time all rheumatologist dont really want to initiate steroids as they have the risk of lowering immunity. I would suggest you dump that tablet and if possible get a new prescription for it.For first line try anti inflammatory like celecoxib or etoricoxib or whichever is available there , it is a safer option..If it doesnt settle go with short course of steroids for 15 to 20 days.

These are the tough times, so just have to manage it in the best possible way without lowering your immunity and giving you the maximum benefit. If you have any contacts here I can arrange for Xeljanx for you but not sure how we can get it across as well as international cargos all seem shut

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Naval Mendiratta (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (1 hour later)

I have a contact in XXXXXXX but they want $300 a bottle for 60 tablets 5mg.

Cargo is still working.

Anybody cheaper?

M

Follow up: Dr. Naval Mendiratta (0 minute later)

I have a contact in XXXXXXX but they want $300 a bottle for 60 tablets 5mg.

Cargo is still working.

Anybody cheaper?

M

Answered by Dr. Naval Mendiratta (27 minutes later)

Brief Answer:
Xeljanz Cost

Detailed Answer:
Dear XXXXXXX

I can arrange for a cheaper one at around 230-240 dollars. Costs have come down a bit, so at INR 18000 can arrange it for you. You can give your contact my number/email so they can get in touch with me when they need it.

Number: +0000
Email: YYYY@YYYY

Take care

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Answered by Dr. Naval Mendiratta (0 minute later)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (11 hours later)

Hi Dr.Mendiratta

This is a good price.

I will contact you soon about the next step.

One more question.

I know a little about Aryuveda.

What foods to avoid at all costs considering my condition?

Is sugar okay?

I do Yoga and meditation everyday.

M

Follow up: Dr. Naval Mendiratta (0 minute later)

Answered by Dr. Naval Mendiratta (5 hours later)

Brief Answer:
Food to be taken

Detailed Answer:
Good afternoon XXXXXXX

Ayurveda medicines I wont recommend for you. With diet now studies have a proven evidence against consumption of red meat and sea food. Red meat has shown to trigger the inflammation. Avoid smoking at all cost. Thirdly u can increase ginger,pomegranates,citrus fruits,brocolli.All these are natural anti oxidants which help control inflammation

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Nagamani Ng