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What Causes Pain In Right Hand In An Arthritis Patient?
Question: Dear Doctor,
My mother ( age 61) is suffering from arthritis type symptoms with a lot of pain in her right hand since the last one month ( she has no other pain). Her doctor has made her take a few tests - Vastulitis , Anti - nuclear anti-body - XXXXXXX profile , angiotensin, convertin enzyme , syrum, anti nuclear anti body/FACTOR (ANA/ANF)
she has been a long time diabetes patient since the last 20 years. Her PP is around 225-250.
While the test results are still due , she has been prescribed the following medicines --folifrax 15mg,folite 5mg,hcqs 200mg,naprosyn 500mg.
I have a few questions (1) what are the alternatives she has to address these early symptoms?(2) are the tests given to her appropriate (3) what are the side effects of the medicine? (4) can this be correlated to her diabetes
Thank you, I look forward to your responses.
Best,
XXXXXX
My mother ( age 61) is suffering from arthritis type symptoms with a lot of pain in her right hand since the last one month ( she has no other pain). Her doctor has made her take a few tests - Vastulitis , Anti - nuclear anti-body - XXXXXXX profile , angiotensin, convertin enzyme , syrum, anti nuclear anti body/FACTOR (ANA/ANF)
she has been a long time diabetes patient since the last 20 years. Her PP is around 225-250.
While the test results are still due , she has been prescribed the following medicines --folifrax 15mg,folite 5mg,hcqs 200mg,naprosyn 500mg.
I have a few questions (1) what are the alternatives she has to address these early symptoms?(2) are the tests given to her appropriate (3) what are the side effects of the medicine? (4) can this be correlated to her diabetes
Thank you, I look forward to your responses.
Best,
XXXXXX
Brief Answer:
? arthritis
Detailed Answer:
Good evening XXXXXXX
Thank you for writing on health care magic
I have gone through your history
Considering only one month of pain in the right hand, I am not too sure if it is the joints or is it the nerves involved here
Addressing your queries
1. As for alternatives you can't do much if it is the beginning of arthritis as the medications prescribed look like it is the start of it. Best is to treat it early.
2. The tests are appropriate but a little more extensive than what would have been required at this stage . never the less it will exclude any other cause we may miss out
3. As for folitrax and hcqs they are very well tolerated. Folitrax causes a bit of nausea and vomiting but if tolerated it doesn't cause much side effects. But yes you need to monitor your complete blood count and liver function tests periodically. Hcqs is a well tolerated drug but considering her diabetes as a background I would tecommt you to get an Opthalmology examination done before starting it as long term side effects are there on the eyes
4. Yes it can be co related to diabetes as well. I am still not sure here if it is rheumatoid arthritis for which ate you being treated as it is involving only one hand. I would like to rule out any nerve involvement or diabetic Cherioarthropathy( joint pains in diabetes patients but no inflammation as such)
Well we can wait and look at the blood tests reports. Hope the information is useful
Do let me know for more queries
Regards
Dr naval
? arthritis
Detailed Answer:
Good evening XXXXXXX
Thank you for writing on health care magic
I have gone through your history
Considering only one month of pain in the right hand, I am not too sure if it is the joints or is it the nerves involved here
Addressing your queries
1. As for alternatives you can't do much if it is the beginning of arthritis as the medications prescribed look like it is the start of it. Best is to treat it early.
2. The tests are appropriate but a little more extensive than what would have been required at this stage . never the less it will exclude any other cause we may miss out
3. As for folitrax and hcqs they are very well tolerated. Folitrax causes a bit of nausea and vomiting but if tolerated it doesn't cause much side effects. But yes you need to monitor your complete blood count and liver function tests periodically. Hcqs is a well tolerated drug but considering her diabetes as a background I would tecommt you to get an Opthalmology examination done before starting it as long term side effects are there on the eyes
4. Yes it can be co related to diabetes as well. I am still not sure here if it is rheumatoid arthritis for which ate you being treated as it is involving only one hand. I would like to rule out any nerve involvement or diabetic Cherioarthropathy( joint pains in diabetes patients but no inflammation as such)
Well we can wait and look at the blood tests reports. Hope the information is useful
Do let me know for more queries
Regards
Dr naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Doctor,
Thank you for your advise a few weeks back, my mom's tests led to diagnosis of TB as she had fluid around her lungs. The doctor has prescribed the following medicines for curing TB and she is facing a few symptoms since she started these medicines, request your advise on (1) are these medicines right? (2) are there any alternates to these medicines (3) could these side effects be linked to the TB medicines? (4) what can we do to control these side effects?
TB medicines prescribed : RCI NEX , Combutol, Lerobact, Bendadon, Omnacortil. side effects that she is facing are : Vomitting after taking R cinex and Combutol and today she had a fit.
I look forward to your recommendations.
Best Regards,
XXXXXXX
Thank you for your advise a few weeks back, my mom's tests led to diagnosis of TB as she had fluid around her lungs. The doctor has prescribed the following medicines for curing TB and she is facing a few symptoms since she started these medicines, request your advise on (1) are these medicines right? (2) are there any alternates to these medicines (3) could these side effects be linked to the TB medicines? (4) what can we do to control these side effects?
TB medicines prescribed : RCI NEX , Combutol, Lerobact, Bendadon, Omnacortil. side effects that she is facing are : Vomitting after taking R cinex and Combutol and today she had a fit.
I look forward to your recommendations.
Best Regards,
XXXXXXX
Brief Answer:
Your Tuberculosis medications seem Adequate...
Detailed Answer:
Good evening XXXXXXX
Thank you for writing on health care magic
The fluid around the lungs, that too on one side and in a diabetic patient can be very well tuberculosis.
Considering your queries:
1. Yes the medications are right. I am only wondering why she hasn't been started with Pyrazinamide and been giving Levoflox instead. Pyrazinamide is the first line therapy and we normally add levoflox if it isn't responding. You can consult your doctor for the same. Cause levoflox does lower the threshold for fits as well. Omnacortil is a bit of steroid which some doctors use for pleural effusion, but it can be tapered off slowly as it will effect the blood sugar as well.
2. There are no alternatives to these medicines. If it is confirmed TB, it is best to be treated with these drugs
3. Yes the vomiting can very well be a part of it.You need to monitor your liver functions tests initially as these medications can increase the liver enzymes. If she is experiencing vomiting frequently, i would advise to take some anti-emetic( like domperidone or emset before taking the medicine) and start the medicines one by one. Like you can ask her to take rcinex for 3 days and if she tolerates it, then add the next drug. Considering her diabetic status, we wont want to dehydrate her with excessive vomiting.
4. IF she had a fit today, i will suggest to admit her. If there is tuberculosis in the lungs, i would recommend a scan and CSF studies to rule out any tuberculosis in the brain as well. Cause with old age and other co-morbid status, it is always advisable to rule it out as well.
5. I would recommend you to stop Folitrax for now till the tuberculosis gets better. I wasn't sure if it was rheumatoid arthritis initially,but wouldn't recommend you to continue it at this stage.
Feel free to ask me for more queries. Would be happy to help you out
Regards
Dr Naval
Your Tuberculosis medications seem Adequate...
Detailed Answer:
Good evening XXXXXXX
Thank you for writing on health care magic
The fluid around the lungs, that too on one side and in a diabetic patient can be very well tuberculosis.
Considering your queries:
1. Yes the medications are right. I am only wondering why she hasn't been started with Pyrazinamide and been giving Levoflox instead. Pyrazinamide is the first line therapy and we normally add levoflox if it isn't responding. You can consult your doctor for the same. Cause levoflox does lower the threshold for fits as well. Omnacortil is a bit of steroid which some doctors use for pleural effusion, but it can be tapered off slowly as it will effect the blood sugar as well.
2. There are no alternatives to these medicines. If it is confirmed TB, it is best to be treated with these drugs
3. Yes the vomiting can very well be a part of it.You need to monitor your liver functions tests initially as these medications can increase the liver enzymes. If she is experiencing vomiting frequently, i would advise to take some anti-emetic( like domperidone or emset before taking the medicine) and start the medicines one by one. Like you can ask her to take rcinex for 3 days and if she tolerates it, then add the next drug. Considering her diabetic status, we wont want to dehydrate her with excessive vomiting.
4. IF she had a fit today, i will suggest to admit her. If there is tuberculosis in the lungs, i would recommend a scan and CSF studies to rule out any tuberculosis in the brain as well. Cause with old age and other co-morbid status, it is always advisable to rule it out as well.
5. I would recommend you to stop Folitrax for now till the tuberculosis gets better. I wasn't sure if it was rheumatoid arthritis initially,but wouldn't recommend you to continue it at this stage.
Feel free to ask me for more queries. Would be happy to help you out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you Dr. Naval for your advise. Her doctor has replaced her medicines - R cinex and Levolflox with daily injection of streptomycin, they are continuing combutol. In addition the neurologist has given an anti-fit tablet and the TB doctor has prescribed a tonic for protecting liver.
Please advise if Streptomycin in your opinion is the right way to go? On her day 1 today she feels much better and has shown none of the previous mentioned side effects.
The injection will be a daily dose for 2 months.
Best,
XXXXXX
Please advise if Streptomycin in your opinion is the right way to go? On her day 1 today she feels much better and has shown none of the previous mentioned side effects.
The injection will be a daily dose for 2 months.
Best,
XXXXXX
Brief Answer:
Tuberculosis Medications
Detailed Answer:
Good evening XXXXXXX
Well streptomycin is a good drug. But you need to keep a watch on her kidney functions as she is diabetic as well. I can only wonder why she hasnt been given Tablet Pyrazinamide yet.( probably doctor would have thought of some factor against it). You can discuss it out with them the next time regarding this drug as well.
Dont worry, she will get better with tolerating medicines. These medicines are quite strong, so lot of patients face these side effects. But in due course of time, they do adjust.
I think she is good to go with these medicines but just keep a watch on her liver and kidney function tests.
Feel free to buzz me for more queries
Regards
Dr Naval
Tuberculosis Medications
Detailed Answer:
Good evening XXXXXXX
Well streptomycin is a good drug. But you need to keep a watch on her kidney functions as she is diabetic as well. I can only wonder why she hasnt been given Tablet Pyrazinamide yet.( probably doctor would have thought of some factor against it). You can discuss it out with them the next time regarding this drug as well.
Dont worry, she will get better with tolerating medicines. These medicines are quite strong, so lot of patients face these side effects. But in due course of time, they do adjust.
I think she is good to go with these medicines but just keep a watch on her liver and kidney function tests.
Feel free to buzz me for more queries
Regards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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