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Suggest Treatment For Rheumatoid Arthritis

Posted on Mon, 10 Jul 2017

Question: I was diagnosed with Rheumatoid Arthritis July 2016. I was on steriods for 3 months, then Methotrexate for 4 days...I could not tolerate it. I have been on Leflunomide (Arava) since Nov. 2016 at 20mg one daily. I was diagnosed with peripheral neuropathy by another doctor. Two weeks ago I quit the Leuflunomide and now I have more feeling in my feet. I do realize it can take up to two years to completely get it out of your system. Other than the peripheral neuropathy I have no other symptoms. I saw my rheumatologist last week and she drew extensive labs. My gamma globulin is low at .5, alpha2 is high at 1.1 , creatinine is low-.6, and on the serum protein electrophoresis it showed I have hypogammaglobulinemia. Calcium is within range at 9.8. My monocytes are high at 14.2, folate is high at over 20, B-12 is in range at 699. They ran free light chains. The Kappa is 0.7890, the Lambda is 0.3180, both within range. However, the Kappa Lambda ratio is 2.51, elevated from the normal range. My rheumatologist wants me to see a hematologist/oncologist for possible myeloma. I will, but the appointment may take awhile, so could you please share your thoughts as to whether this could be myeloma or a medication induced reaction by the Leflunomide. I have attached a copy of my current labs run on XXXXXXX 7, 2017. Thank you very much, XXXXXXX Loudon

Answered by Dr. Hardik Sanghvi (1 hour later)

Brief Answer:
Please send me your all reports.

Detailed Answer:
Hi, dear
I have gone through your question.
I can understand your concern.

Pleases send me your all reports through which you have already gone through. So that I can help you further. There is an option to upload reports on this page.

I will wait for your reports.

Thanks for using health care magic.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hardik Sanghvi (1 hour later)

These are my only lab results, which I just uploaded again...please let me know if you received them, XXXXXXX It states upload has some errors, I will try doing it via dropbox if you send me your email, thank you.

Answered by Dr. Hardik Sanghvi (7 hours later)

Brief Answer:
I don't get your reports.

Detailed Answer:
Hi dear
still I don't get your reports.
If you have any problems in uploading reports then you can take help of our customer care. Or you can mail me at YYYY@YYYY

Thanks for using health care magic.

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

Follow up: Dr. Hardik Sanghvi (11 hours later)

Thank you Dr. XXXXXXX Sanghvi. I just sent you an email with my lab results in a PDF file. I have done further research and possibly the DMARD, Leflunomide, is causing bone marrow suppression as well as demyelation, peripheral neuropathy.
At least that is what I am hoping. XXXXXXX

Answered by Dr. Hardik Sanghvi (13 hours later)

Brief Answer:
Still I don't get your laboratory results.

Detailed Answer:
Hi, dear
I have gone through your question.
I can understand your concern.

Still I don't get any laboratory results. without that it's very difficult to comment about myeloma.Y our peripheral neuropathy may be due to your DMRDS.

Please send me your all reports. If you have difficulty then contact our customer care department.

I will wait for your reports.

Thanks for using health care magic.

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

Follow up: Dr. Hardik Sanghvi (9 hours later)

I just resent you an email at your Yahoo address. I never received the first one back. In the title it has "lab results XXXXXXX xxxxxxx xxxxxx xxxxx xxxxxx". Hopefully you will get the email with the attached lab results, thank you, XXXXXXX Did you get my email..I resent it 4 hrs. ago to the yahoo address you gave me and it has not been returned. Please let me know if you received it, thank you.Please look in your spam filter for my email. It must be there. Even if not good, please let me know what you think...I need answers, thank you, XXXXXXX

Answered by Dr. Hardik Sanghvi (37 hours later)

Brief Answer:
I still didn't get any mail.

Detailed Answer:
Hi, dear
I have gone through your question.
I can understand your concern.

I still don't get any mail or uploaded reports. Please contact our customer care department for help. They will send me.
You can also choose to send the files to YYYY@YYYY with attention to Dr Hardik Sanghvi. The customer care will be able to send me those files.

I will wait for your reports.

Thanks for using health care magic.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Hardik Sanghvi (11 hours later)

I just sent my lab results to Health Care Magic, via your attention. If you do not receive them something is really wrong...very frustrating!

Answered by Dr. Hardik Sanghvi (18 hours later)

Brief Answer:
It is due to your rheumatoid arthritis and leflunomide.

Detailed Answer:
Hi, dear
I have gone through your question.
I have gone through your all reports.
I can understand your concern.

Your peripheral neuropathy is most likely to be due to leflunomide. Discontinuation of drug will improve condition.

Your all other reports are normal. But your kappa light chain level is high. So you may have kappa light chain myeloma or you may develop in future.

Light chain abnormalities are common in rheumatoid arthritis patients to chronic stimulation. So mostly it is due to your rheumatoid arthritis.

You should go for regular follow up with protein electrophoresis and light chain assay.

Consult your hematologist as early as possible and plan accordingly.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer.
Thanks for using health care magic.

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

Follow up: Dr. Hardik Sanghvi (3 hours later)

Dear Dr. Sanghvi,

Thank you very much for your answers. I am confused about something however.
The normal range for kappa free light chains is 0.33--1.94 and mine is 0.7980.
Wouldn't that be within the normal range? If you could please explain I would appreciate it, thank you, XXXXXXX

Answered by Dr. Hardik Sanghvi (29 hours later)

Brief Answer:
Kappa to Lamda ratio is more important.

Detailed Answer:
Hi, dear
I have gone through your question.
I can understand your concern.

Your kappa light chain level is within range. But kappa to Lamda ratio is more important than individual chain level.

Your kappa to Lamda ratio is higher than normal. So there is chance of light chain myeloma. Rheumatoid arthritis patients have these types abnormalities due to stimulation by chronic inflammation.

Thanks for using health care magic.
Wish you a very good health.

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Above answer was peer-reviewed by : Dr. Prasad