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Hello Doctor. My Mother, Aged 50, Has Been Suffering From

Posted on Tue, 6 Jun 2023

Question: Hello Doctor. My mother, aged 50, has been suffering from Joint pains for the past 4 to 5 years (at random intervals), specially in knees and shoulders. This year, her pain was so severe that she met a rheumatologist and he ordered a series of tests. After seeing her Knee MRI, he said that he would start with biologics injection to reduce severe inflammation in her legs. He also ordered Chest Xray and after seeing 'pleural thickening' remark in it, he ordered for a Chest HRCT since her lung fields should be clear before starting Biologics. In Chest HRCT, it was given 'interstitial lung disease'.

I have attached all the reports here. Please go through them and brief us about ILD. Is it dangerous? Does she have it as suggested in the HRCT report? Can we proceed with biologics injection with this condition?

Answered by Dr. Drkaushal85 (56 minutes later)

Brief Answer:
She might be having some connective tissue disease.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the history you have given.
I have also gone through the reports you have attached.
CT report is suggestive of interstitial lung disease (ILD).
Honestly speaking, there are many types of ILDs.
In her case, she might be having connective tissue disease (CTD).
CTD can cause joint pains and ILD pattern on HRCT.
To answer about severity, I want to know few more things.
1. Does your mother have cough, breathlessness?
2. Has she undergone ANA profile test?
3. Which biological injection you are talking about?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your mother. Thanks.

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

Follow up: Dr. Drkaushal85 (58 minutes later)

Dear Doctor,

Thanks for the reply. As you asked, she doesn't have cough or breathlessness. I have attached ANA report as well as other blood reports taken recently as suggested by her Rheumatologist. Her doctor does not give detailed information on biologics inspite of asking for it. It's weekly injection to be taken for a total of 6 weeks and costs around 15000 each.

Can biologics aggravate ILD? Meanwhile he has prescribed medicines like Azith 500 mg, Rheulef 20mg, Predinisol M4, Mexate, Nuroplex and calcium tablets.

Answered by Dr. Drkaushal85 (18 minutes later)

Brief Answer:
How's her joint pain after starting these drugs?

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
I have gone through the blood reports you have attached.
He should have told you the name of injection.
This is not good practice.
Please let me know
1. How's her joint pain after starting these drugs?
Please reply me answer of above asked question, so that I can guide you better.
I will be happy to help you further. Wishing good health to your mother. Thanks.

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

Follow up: Dr. Drkaushal85 (29 minutes later)

Doctor, it has been just a day since she started these drugs

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
You should consult orthopedic doctor with this MRI.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In my opinion, you should wait and don't rush for biological injection.
Better to consult orthopedic doctor with this MRI report.
Have you consulted orthopedic report after this MRI?
I will be happy to help you further. Wishing good health to your mother. Thanks.

Note: For further follow up on related General & Family Physician Click here.

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