Hi XXXXXXX

Thanks for writing to us.

The reports of XXXXXXX Pandey appear normal except deranged blood sugar value though HbA1c level shows well controlled blood sugar in the past 3 months. So this patient may be glucose intolerant and it needs to be addressed. She is not obese but slightly overweight with BMI 28. Elevated ESR and C-reactive protein are not concerning probably related to current infection or previous rheumatoid arthritis. Rest of the reports are normal.

In this context, the mouth ulcers may be related to the current infection / diabetes / other causes.

I would suggest the following for XXXXXXX Pandey -
1. Diet - salt and sugar restricted diet, less in amount and more in frequency, calorie restriction. Consume food with low glycemic index like peas, bins, dry fruits etc. Rice to be taken only once daily. Avoid ice-cream, cold drinks and junk food.
2. Regular exercise and morning walk.
3. 3-4 litre water per day.
4. Ensure food after each dose of glimepiride.
5. Candid mouth paint to be applied locally twice daily.
6. Tab. Paracetamol 500 mg as and when required for fever.
7. Also do TLC and DC of blood if not done yet.
8. Weight reduction measures to ensure BMI comes under 25.
9. Small dose of oral hypoglycemic drug can be taken under the supervision of her physicians.

Hope I have answered your queries. If you want to know further you are free to ask me. Please write a review on this answer.

Wishing quick recovery of the patient and good health

Regards,

Dr. Arnab Maji

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Hi XXXXXXX

Thanks for writing back to me.

Thanks for providing the additional information, which I asked for.

The TLC and DC are within normal limit.

Before giving additional treatment for R.A., it is important to assess the disease activity in her. For that you have to let me aware of the current status of joint involvement, any deformity has already occurred or not, any sign of joint inflammation like pain, redness, stiffness and swelling of the involved joint. In addition, you have to have a serum anti-CCP level. I don’t know what kind of treatment she received for R.A. in the past except chloroquine. Please let me be aware of those facts.

If the R.A. is active now and there is persistent elevation of anti-CCP level then you need additional treatment in the form of methotrexate, azathioprin, steroids or biologicals like infliximab. If disease is not active now and deformity has already there then there will not be any added benefit by adding these drugs with the persisting treatment.

Hope I have answered your query. If you want to know, further you can freely write back to me. If you have no such query, you may close this discussion here and write a review on this answer.

God bless you.

Regards,

Dr. Arnab Maji

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Hi XXXXXXX

Thanks for meeting up my queries.

As there is no inflammation of small joints at present, only there is slight knee pain while climbing up-stairs no added treatment is required right now.

But I advise you to go for estimation of serum anti-CCP level now.

Hope I have answered your query. If you want to know, further you can freely write back to me. If you have no such query, you may close this discussion here and kindly write a review on this answer.

Regards,
Dr. Arnab Maji

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