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What Does My Lab Test Report Indicate?
Question: When I wrote before, I asked whether it would be advisable to stop taking the Orencia I have been taking for years, because I couldn’t tell if it was doing any good, but at great cost. I was advised that a common combination your drs. used was Methotrexate with Leflunomide. I discussed this with my primary care dr. & he wrote me a prescription for the latter (I was already taking Methotrexate) but since then have had ultrasounds & CT scans of my kidneys & liver, & they showed damage to both. The report indicated an enlarged liver with increased echogenicity, which may represent fatty infiltration or cirrhosis (I don’t drink & never have to any extent), 4 small liver cysts, atrophic right kidney,& some other cysts & polyps. After reading the information on Leflunomide, I was unsure if it might cause damage to the kidney or liver.My question is whether it seems safe to take the Leflunomide.
Brief Answer:
Leflunomide safety
Detailed Answer:
Good evening
Thank you for writing on health care magic
I think I was the one who had answered you before also and advised you the combination which we use routinely...in substitute of biological drugs..
As per your query, Leflunomide does not affect the kidneys..Rather in patients with kidney disease, we prefer using leflunomide over the methotrexate in the modified dose..
2. The action of leflunomide, wouldn't have come yet...It normally takes 6-8 weeks for the action to start...Methotrexate has more of side effects on liver than leflunomide.
I would like to know a few things..
1.. Why was the CT performed in the first place..Did you experience any symptoms or was it routinely carried out?
2. How are the blood tests for liver function and kidneys?
The cysts and the polyps are very normal with age..Most of them are benign and do not cause much harm...So the blood tests and the symptoms are important to know..
Do let me know these queries
REgards
Dr Naval
Leflunomide safety
Detailed Answer:
Good evening
Thank you for writing on health care magic
I think I was the one who had answered you before also and advised you the combination which we use routinely...in substitute of biological drugs..
As per your query, Leflunomide does not affect the kidneys..Rather in patients with kidney disease, we prefer using leflunomide over the methotrexate in the modified dose..
2. The action of leflunomide, wouldn't have come yet...It normally takes 6-8 weeks for the action to start...Methotrexate has more of side effects on liver than leflunomide.
I would like to know a few things..
1.. Why was the CT performed in the first place..Did you experience any symptoms or was it routinely carried out?
2. How are the blood tests for liver function and kidneys?
The cysts and the polyps are very normal with age..Most of them are benign and do not cause much harm...So the blood tests and the symptoms are important to know..
Do let me know these queries
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the information. I believe the CT & ultrasounds were performed after I had significant blood in my urine. I was also found to have e coli, for which I was treated with antibiotics. It definitely wasn't routine. I will be talking to my primary care physician this week & will ask him about the blood tests for liver & kidneys. They do send me results, but usually I don't have the medical knowledge to interpret them myself--I have been slightly outside the normal range but the dr. has always dismissed them as not significant. I did write down the results, but now I am unable to find them. Could you tell me which parts of the CBC I am looking for, & I will try to be better about keeping track of them.
I guess it will be safe to start taking the leflunomide. I have cut back some on the methotrexate to 6 per week. I could try cutting back further if it is causing most of the problems.
I guess it will be safe to start taking the leflunomide. I have cut back some on the methotrexate to 6 per week. I could try cutting back further if it is causing most of the problems.
Brief Answer:
Delayed Reply
Detailed Answer:
Good evening
Sorry for the late reply..Just got free from home and work duties
I think they did do lot of investigations for the blood in urine and the findings of cysts in liver and polyps in kidneys are mostly incidental. With age these sort of cysts and polyps keep coming up, but usual they dont cause much symptoms or affect the blood tests..
1. You need to check for the liver function tests..SGOT, SGPT and Serum ALbumin. If they are all ok, it will be safe to continue methotrexate and leflunomide
2. For CBC, Keep a watch on haemoglobin and complete blood count as they can get suppressed at times ...
But yes I still feel, LEflunomide is a safer option than Orencia especially when you had such a complicated urine infection...IT wont lower your immunity so much
IF you could get hands on results do let me know. I will interpret them and let you know the results of it
Hope the information was useful
REgards
Dr Naval
Delayed Reply
Detailed Answer:
Good evening
Sorry for the late reply..Just got free from home and work duties
I think they did do lot of investigations for the blood in urine and the findings of cysts in liver and polyps in kidneys are mostly incidental. With age these sort of cysts and polyps keep coming up, but usual they dont cause much symptoms or affect the blood tests..
1. You need to check for the liver function tests..SGOT, SGPT and Serum ALbumin. If they are all ok, it will be safe to continue methotrexate and leflunomide
2. For CBC, Keep a watch on haemoglobin and complete blood count as they can get suppressed at times ...
But yes I still feel, LEflunomide is a safer option than Orencia especially when you had such a complicated urine infection...IT wont lower your immunity so much
IF you could get hands on results do let me know. I will interpret them and let you know the results of it
Hope the information was useful
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I looked up my last CBC & metabolic panel results & some were high & some low, but most very close to the normal range. The albumin was OK, but the other things you mentioned--SGOT & SGPT--were not listed that way. My Hemoglobin was low--11.0g/dL--& RDW (whatever that means) was 18.3%, & AST & Alt were ok. Creatinine was 1.12mg/dL & EFGR 50. MCHC 31.3, Neutrophils 7.7, & Absolute lymphocyts .06x10E. Some of these I have shortened slightly, but none were alarmingly out of normal. As I said, I don't know what to look for or how to interpret these results, & they don't seem to match what you said to look for. I am seeing my dr. today & will ask him if I could have a new blood test, both to see that the e coli problem has been resolved & to look specifically for liver & kidney problems.
Thank you for your help.
Thank you for your help.
Brief Answer:
Reports interpretation
Detailed Answer:
Good evening
Sorry for the delayed reply. Had a long day
Well, AST and ALT are same as SGOT and SPGT..Since all your tests are normal, I dont think you need to worry about the liver as the blood results are doing good. The cysts can just be incidental finding...
But yes, the creatinine is just on the borderline..So that is something we have to keep a watch on..and minimize the use of painkillers for rheumatoid arthritis. Something like tylenol or paracetamol are the safest bet.
I think you are okay to continue with Leflunomide and Methotrexate. You can discuss with your doctor and as long as he is confident enough to continue, it shouldn't be a problem as we cant let your arthritis flare after stopping Orencia.
I hope the information was useful
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Reports interpretation
Detailed Answer:
Good evening
Sorry for the delayed reply. Had a long day
Well, AST and ALT are same as SGOT and SPGT..Since all your tests are normal, I dont think you need to worry about the liver as the blood results are doing good. The cysts can just be incidental finding...
But yes, the creatinine is just on the borderline..So that is something we have to keep a watch on..and minimize the use of painkillers for rheumatoid arthritis. Something like tylenol or paracetamol are the safest bet.
I think you are okay to continue with Leflunomide and Methotrexate. You can discuss with your doctor and as long as he is confident enough to continue, it shouldn't be a problem as we cant let your arthritis flare after stopping Orencia.
I hope the information was useful
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I just want to thank you for your input. It helped in having a discussion with my primary care dr. I am cutting back on the painkillers, but can't go too far with that as I couldn't even get out of bed much less out of the house without some of them as they at least allow me to move.
One last thing: I can't remember now if I told you that I take 7mg of Prednisone every day, & of course that's what my dr. wants me to cut back, although I only fairly recently went up to 7mg. from the 5 I had been on for years. One rheumatologist I respected very much years ago told me that that level of maintenance dose was acceptable because it was about what my (one's?) body would produce normally. I do know that it is literally the only thing I have ever taken that has a noticeable effect on the swelling & other symptoms so of course I feel I need to take it even if it does have side effects. I'd like to hear your input on this & then I will close down this discussion. Thank you again for your helpful input. It has been a blessing to me to have a specialist to talk to when we have none anywhere near where I live.
One last thing: I can't remember now if I told you that I take 7mg of Prednisone every day, & of course that's what my dr. wants me to cut back, although I only fairly recently went up to 7mg. from the 5 I had been on for years. One rheumatologist I respected very much years ago told me that that level of maintenance dose was acceptable because it was about what my (one's?) body would produce normally. I do know that it is literally the only thing I have ever taken that has a noticeable effect on the swelling & other symptoms so of course I feel I need to take it even if it does have side effects. I'd like to hear your input on this & then I will close down this discussion. Thank you again for your helpful input. It has been a blessing to me to have a specialist to talk to when we have none anywhere near where I live.
Brief Answer:
Prednisolone dosage
Detailed Answer:
good evening
thanks for your reply.
Well your rheumatologist was right, eve I had suggest to taper the steroid dose to minimum as it can cause osteoporosis especially in your age. But yes some people do have a good response only to steroids.
I would suggest you try on maximum tolerated dose of methotrexate and leflunomide. if it works we can remove painkillers and slowly slowly steroids. I hope you are taking calcium vitamin d and bisphophonates.
Lastly I ll say steroid tapering can be harder than anything as it is just like a drug. and pain increases on tapering the dose.. but yes go off painkillers
one more suggestion.. if it is a seropositive arthritis I would suggest you go for rituximab.. once in 6 months therapy
it has been a pleasure to assist you. I ll be around for any more queries you have.
regards
Dr naval
Prednisolone dosage
Detailed Answer:
good evening
thanks for your reply.
Well your rheumatologist was right, eve I had suggest to taper the steroid dose to minimum as it can cause osteoporosis especially in your age. But yes some people do have a good response only to steroids.
I would suggest you try on maximum tolerated dose of methotrexate and leflunomide. if it works we can remove painkillers and slowly slowly steroids. I hope you are taking calcium vitamin d and bisphophonates.
Lastly I ll say steroid tapering can be harder than anything as it is just like a drug. and pain increases on tapering the dose.. but yes go off painkillers
one more suggestion.. if it is a seropositive arthritis I would suggest you go for rituximab.. once in 6 months therapy
it has been a pleasure to assist you. I ll be around for any more queries you have.
regards
Dr naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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