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How Long Should Sazo, Osicare Plus And Crocin Be Taken By A Diabetic Patient?
Question: My mother is 61 years old and obese. She has Hypothyroid, which is under control. BP is normal. Lipid profile, ECG is also normal.
But she also has HIGH Sugar PP (190) and most likely suffering from RA. All her body joints (Hands, knee, shoulder, feet) are in pain all the time. She cannot fold her fingers or raise her hand properly. She can't even walk properly or climb stairs. She is very unfit due to lack of much physical activity for the past 3 years. She has to mostly remain indoors.
Last test results in May-July 2014:
RA factor was 10.88.
C-Reactive Protein was 32.7.
25(OH) - Vitamin D3 was 17.1 ng/ml ( Rectified by Uprise D3 capsules @ once/week for 5 weeks)
Free T4 - 1.48 ng/dl
TSH - 2.6 uIU/ml
Sugar Fasting - 95
Sugar PP - 190 (Recent)
HbA1C was 6.6%
Vitamin B12 - 356 pg/mL
Creatinine - 0.63 mg/dl
ANTI NUCLEAR ANTIBODY (HEP-2) - 17.7 Index Value
ANTI-CCP - 4.2 U/ml
HLA-B27 - Negative
Haemoglobin - 11.2 Gm%
ESR - 48mm
Spot Urine Microalbumin - 13.6 mg/L
Creatinine Urine 47 mg/dL
Albumin/Creatinine Ratio - 28.94
ECG - Normal
She takes the following medicines currently:
Azulix 2 mg - 1 tab Before breakfast
Thyrox 100 - 1 tab Before breakfast
Rabekind 20 - 1 tab Before breakfast
Insulin Novomix with Pen. 20 units/day Before Lunch
Cetapin XR 1000 - 1 tab After Lunch and After Dinner
Vozuca 0.3 - 1 per day After Lunch
Crocin 650 - 1 per day After Lunch
Sazo 1000 - 1 per day After Lunch and 1 per day After Dinner
Folvite 5 mg - 1 per day After Lunch
Osicare Plus - 1 per day after Lunch
Fourts' B -1 per day After Lunch
Women Horlicks
Omnacortil 10 - 1 per day for 2 weeks on Emergency SOS.
We tried physiotherapy, ointments, painkillers and Hot Water Press but to no effect. She was also administered Depo Medrol twice but to no effect. Initially a mild dose of Omnacortil 10 for 2 weeks with would subside the pain but now mild doses do not work.
My question is how long should all these medicines(especially Sazo, Osicare Plus and Crocin) be taken since she has diabetes? Can she take steroids in emergency or on regular basis? Also please suggest other remedies/precautions. I have attached some X-rays reports.
But she also has HIGH Sugar PP (190) and most likely suffering from RA. All her body joints (Hands, knee, shoulder, feet) are in pain all the time. She cannot fold her fingers or raise her hand properly. She can't even walk properly or climb stairs. She is very unfit due to lack of much physical activity for the past 3 years. She has to mostly remain indoors.
Last test results in May-July 2014:
RA factor was 10.88.
C-Reactive Protein was 32.7.
25(OH) - Vitamin D3 was 17.1 ng/ml ( Rectified by Uprise D3 capsules @ once/week for 5 weeks)
Free T4 - 1.48 ng/dl
TSH - 2.6 uIU/ml
Sugar Fasting - 95
Sugar PP - 190 (Recent)
HbA1C was 6.6%
Vitamin B12 - 356 pg/mL
Creatinine - 0.63 mg/dl
ANTI NUCLEAR ANTIBODY (HEP-2) - 17.7 Index Value
ANTI-CCP - 4.2 U/ml
HLA-B27 - Negative
Haemoglobin - 11.2 Gm%
ESR - 48mm
Spot Urine Microalbumin - 13.6 mg/L
Creatinine Urine 47 mg/dL
Albumin/Creatinine Ratio - 28.94
ECG - Normal
She takes the following medicines currently:
Azulix 2 mg - 1 tab Before breakfast
Thyrox 100 - 1 tab Before breakfast
Rabekind 20 - 1 tab Before breakfast
Insulin Novomix with Pen. 20 units/day Before Lunch
Cetapin XR 1000 - 1 tab After Lunch and After Dinner
Vozuca 0.3 - 1 per day After Lunch
Crocin 650 - 1 per day After Lunch
Sazo 1000 - 1 per day After Lunch and 1 per day After Dinner
Folvite 5 mg - 1 per day After Lunch
Osicare Plus - 1 per day after Lunch
Fourts' B -1 per day After Lunch
Women Horlicks
Omnacortil 10 - 1 per day for 2 weeks on Emergency SOS.
We tried physiotherapy, ointments, painkillers and Hot Water Press but to no effect. She was also administered Depo Medrol twice but to no effect. Initially a mild dose of Omnacortil 10 for 2 weeks with would subside the pain but now mild doses do not work.
My question is how long should all these medicines(especially Sazo, Osicare Plus and Crocin) be taken since she has diabetes? Can she take steroids in emergency or on regular basis? Also please suggest other remedies/precautions. I have attached some X-rays reports.
Brief Answer:
?Is it inflammatory Arthritis
Detailed Answer:
Good evening
thank you for writing on health care magic
I have gone through the symptoms and the history. I have seen the X rays as well(although Hand X rays is not so clear, but the report i have read). It doesnt look like inflammatory arthritis to me. The X Ray also shows more of degenerative changes in the knees and the hands than the inflammatory ones.
Well the main thing we need to understand about the pains is it s origin. Pain can be due to many causes..Joints/nerves/muscle.If it is none of the above, it normally has a different origin from the brain. SO we need to be really sure what we are treating and then only the medications make more impact.
1. You told me about her joint pains. I would like to know is there any swelling in the joints as well or is it just pain? Does she experience stiffness in the mornings?
2. The difficulty in climbing stairs is due to Osteoarthritis of the knees. Medications wont make a difference in the advanced condition. She probably will need surgery which will improve the quality of her life.
3. As for omnacortil and Sazo, they both are used for inflammatory arthritis. Sazo is not the first drug of choice for inflammatory arthritis. Usually Methotrexate is. If they want to treat is as inflammatory, then treat it with the first line medication. Or else there is no point of giving 2nd line. Omnacortil she should be avoiding as much as she can as it will alter her diabetes and also continue to increase her weight.
4. I would like to know a few questions: Does she have a good sleep? any history of irritability ? any forgetfullness?
do let me know he queries. I hope the remaining information has been useful. Will try to streamline her treatment
Regards
Dr Naval
?Is it inflammatory Arthritis
Detailed Answer:
Good evening
thank you for writing on health care magic
I have gone through the symptoms and the history. I have seen the X rays as well(although Hand X rays is not so clear, but the report i have read). It doesnt look like inflammatory arthritis to me. The X Ray also shows more of degenerative changes in the knees and the hands than the inflammatory ones.
Well the main thing we need to understand about the pains is it s origin. Pain can be due to many causes..Joints/nerves/muscle.If it is none of the above, it normally has a different origin from the brain. SO we need to be really sure what we are treating and then only the medications make more impact.
1. You told me about her joint pains. I would like to know is there any swelling in the joints as well or is it just pain? Does she experience stiffness in the mornings?
2. The difficulty in climbing stairs is due to Osteoarthritis of the knees. Medications wont make a difference in the advanced condition. She probably will need surgery which will improve the quality of her life.
3. As for omnacortil and Sazo, they both are used for inflammatory arthritis. Sazo is not the first drug of choice for inflammatory arthritis. Usually Methotrexate is. If they want to treat is as inflammatory, then treat it with the first line medication. Or else there is no point of giving 2nd line. Omnacortil she should be avoiding as much as she can as it will alter her diabetes and also continue to increase her weight.
4. I would like to know a few questions: Does she have a good sleep? any history of irritability ? any forgetfullness?
do let me know he queries. I hope the remaining information has been useful. Will try to streamline her treatment
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
1. Yes she has swellings in hands joints with pain and cannot fold her fist or raise arms properly. Yes morning stiffness is there. It was worse in winter but now its better. Pain in knees is less compared to hands and arms. Also she doesn't have muscle pain. Its mainly in joints and bones in palms and knees. She started taking Sazo , Paracetamol and Osicare Plus for last 2-3 months and she has improved slightly. Doctors had stopped giving her other painkillers like aceclofenac.
2. She is overweight and hardly goes out of house. She may have been jammed due to lack of physical activity. Though she can climb stairs slowly with lot of difficulties. We cannot afford surgery.
3. So what medicines should I give instead of Sazo and paracetamol and for how many months? Can I give Omnacortil on Emergency for 1 week? Does she has Arthritis? If yes then what type? What is first line and second line of treatment?
4. She sleeps most of the time except when she cooks, eats or watches tv etc. Yes, my father expired 5 yrs ago and she became very depressed.Suddenly she started forgetting things and looking confused and sweating. We tested it for stroke but it was not. Then slowly it subsided but she doesn't remember things old than 3-4 weeks. Also she cannot tolerate loud sound and people talking too much.
Also in the long past she used to be very angry and kept murmuring words of her own. She snores a lot and sometimes murmur words in sleep. Is there some other disease?
I have enclosed two doctor prescription for your reference.
Can she take paracetamol, osicare plus for life long in diabetes?
Please suggest correct medicines and treatment and duration.
2. She is overweight and hardly goes out of house. She may have been jammed due to lack of physical activity. Though she can climb stairs slowly with lot of difficulties. We cannot afford surgery.
3. So what medicines should I give instead of Sazo and paracetamol and for how many months? Can I give Omnacortil on Emergency for 1 week? Does she has Arthritis? If yes then what type? What is first line and second line of treatment?
4. She sleeps most of the time except when she cooks, eats or watches tv etc. Yes, my father expired 5 yrs ago and she became very depressed.Suddenly she started forgetting things and looking confused and sweating. We tested it for stroke but it was not. Then slowly it subsided but she doesn't remember things old than 3-4 weeks. Also she cannot tolerate loud sound and people talking too much.
Also in the long past she used to be very angry and kept murmuring words of her own. She snores a lot and sometimes murmur words in sleep. Is there some other disease?
I have enclosed two doctor prescription for your reference.
Can she take paracetamol, osicare plus for life long in diabetes?
Please suggest correct medicines and treatment and duration.
Brief Answer:
? Is it Rheumatoid Arthritis
Detailed Answer:
Good evening
Well i have gone through your prescriptions. It does mention the diagnosis of Seronegative Rheumatoid Arthritis but doesnt mention the exact number of swollen and tender joints which we need to examine before labeling it as rheumatoid arthritis.
Pertaining to your queries:
1 and 3: The symptoms you are describing can very well fit in with Diabetic Cherioarthopathy as well. It is a joint condition in long standing diabetics, where the skin over hand becomes a bit tight and shiny and they are unable to flex the fingers. It is a benign condition which tends to settle itself with better blood glucose control. You dont need strong medications for it. But yes, it is a very tough diagnosis to make. One needs to examine the patient before commenting on it. So this confirm statement i cant make without examining her. We normally run an ultrasound of the joints in our institute to make the exact diagnosis as ultrasound can pick up signals way and gives us a clarity on starting medications. If they have that facility in XXXXXXX you should definitely avail it to be sure of the diagnosis. She can continue paracetamol and Osicare. They are safe for her pain and for her knee osteoarthritis. As for omnacortil, i wouldnt want to use it for emergency also as it will affect her blood sugars. But then again, if it s rheumatoid then you can use it. Better alternative is to take an injection of depomedrol 80 mg. That way she wont get dependent on oral steroids and you dont have to worry about her becoming habitual
4. The symptoms you are describing in query 4 fit into Fibromyalgia. YOu can read it up online once. She definitely needs to be on some pain modulators for it as this condition is another cause of generalized pains all over and gets better with treatment. It will improve the quality of her life as well.
I would conclude by saying, the diagnosis of Rheumatoid Arthritis is still a bit uncertain to me, but if a doctor has made the diagnosis probably there is some background to it. But the poor response to Omnacortil doesnt seem to fit in. You should discuss with your doctor for starting Methotrexate than Sazo as it is the first line of drug fr rheumatoid arthritis. . Secondly, she does have fibromyalgia symptoms. You can read up on net for it and discuss with your doctor for starting medications.
Do let me know for more queries
Would be happy to answer them
Regards
Dr Naval
? Is it Rheumatoid Arthritis
Detailed Answer:
Good evening
Well i have gone through your prescriptions. It does mention the diagnosis of Seronegative Rheumatoid Arthritis but doesnt mention the exact number of swollen and tender joints which we need to examine before labeling it as rheumatoid arthritis.
Pertaining to your queries:
1 and 3: The symptoms you are describing can very well fit in with Diabetic Cherioarthopathy as well. It is a joint condition in long standing diabetics, where the skin over hand becomes a bit tight and shiny and they are unable to flex the fingers. It is a benign condition which tends to settle itself with better blood glucose control. You dont need strong medications for it. But yes, it is a very tough diagnosis to make. One needs to examine the patient before commenting on it. So this confirm statement i cant make without examining her. We normally run an ultrasound of the joints in our institute to make the exact diagnosis as ultrasound can pick up signals way and gives us a clarity on starting medications. If they have that facility in XXXXXXX you should definitely avail it to be sure of the diagnosis. She can continue paracetamol and Osicare. They are safe for her pain and for her knee osteoarthritis. As for omnacortil, i wouldnt want to use it for emergency also as it will affect her blood sugars. But then again, if it s rheumatoid then you can use it. Better alternative is to take an injection of depomedrol 80 mg. That way she wont get dependent on oral steroids and you dont have to worry about her becoming habitual
4. The symptoms you are describing in query 4 fit into Fibromyalgia. YOu can read it up online once. She definitely needs to be on some pain modulators for it as this condition is another cause of generalized pains all over and gets better with treatment. It will improve the quality of her life as well.
I would conclude by saying, the diagnosis of Rheumatoid Arthritis is still a bit uncertain to me, but if a doctor has made the diagnosis probably there is some background to it. But the poor response to Omnacortil doesnt seem to fit in. You should discuss with your doctor for starting Methotrexate than Sazo as it is the first line of drug fr rheumatoid arthritis. . Secondly, she does have fibromyalgia symptoms. You can read up on net for it and discuss with your doctor for starting medications.
Do let me know for more queries
Would be happy to answer them
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
1. I will try my best to controlling her sugar levels so that Diabetic Cherioarthopathy is under control if present.
2. Doesn't the X-Ray reveal the exact type of Arthritis? She doesn't have muscle pain. She has pain mostly in hand joints, shoulder joints and knee. What do the following test results indicate?
RA factor was 10.88.
C-Reactive Protein was 32.7.
ANTI NUCLEAR ANTIBODY (HEP-2) - 17.7 Index Value
ANTI-CCP - 4.2 U/ml
HLA-B27 - Negative
3. I read Fibromyalgia symptoms include muscle pain, insomnia, stomach ache, headache, sensitivity to light n odour, jaw tenderness, tingling, fatigue, depression. She doesn't have all these symptoms. Also she didn't react well to antidepressants 4 years ago. But yes she is forgetful and joints in hands are little swollen and she is unable to fold her fists due to pain.
I am including the pictures of her hands.
How can we confirm if she has Fibriomyalgia and what are the basic treatment?
4. I will continue with Paracetamol, Osicare and mild exercises for her. Can these be continued life long?
5. Is Methotrexate safe for diabetic?
6. What is the difference between Methotrexate and Sazo?
7. Are they both safe for long diabetic patients ?
8. Should I replace Sazo 1000 twice a day with Methotrexate?
What should be recommended dosage and duration?
I will appreciate suggestions from you since you are a doctor yourself.
And after this last followup how can I specify your name again on this site for next consultation?
2. Doesn't the X-Ray reveal the exact type of Arthritis? She doesn't have muscle pain. She has pain mostly in hand joints, shoulder joints and knee. What do the following test results indicate?
RA factor was 10.88.
C-Reactive Protein was 32.7.
ANTI NUCLEAR ANTIBODY (HEP-2) - 17.7 Index Value
ANTI-CCP - 4.2 U/ml
HLA-B27 - Negative
3. I read Fibromyalgia symptoms include muscle pain, insomnia, stomach ache, headache, sensitivity to light n odour, jaw tenderness, tingling, fatigue, depression. She doesn't have all these symptoms. Also she didn't react well to antidepressants 4 years ago. But yes she is forgetful and joints in hands are little swollen and she is unable to fold her fists due to pain.
I am including the pictures of her hands.
How can we confirm if she has Fibriomyalgia and what are the basic treatment?
4. I will continue with Paracetamol, Osicare and mild exercises for her. Can these be continued life long?
5. Is Methotrexate safe for diabetic?
6. What is the difference between Methotrexate and Sazo?
7. Are they both safe for long diabetic patients ?
8. Should I replace Sazo 1000 twice a day with Methotrexate?
What should be recommended dosage and duration?
I will appreciate suggestions from you since you are a doctor yourself.
And after this last followup how can I specify your name again on this site for next consultation?
Brief Answer:
Treatment for Rheumatoid ARthritis
Detailed Answer:
Good evening XXXXXXX
Sorry for late reply. Was caught up with the duty
As per your queries:
2. The tests results are negative for Rheumatoid Arthritis. RF and Anti CCP are negative and ANA is inconclusive as well. It can still be seronegative Rheumatoid Arthritis but as mentioned earlier, one needs to examine the patient before labeling it as Rheumatoid Arthritis. CRP is mildly elevated, but then again it can be raised in any infection as well. Xray is suggestive of Osteoarthritis than Rheumatoid Arthritis. So all in all, clinical examination is the key.
3. I have seen the hand pictures. They do look quite puffy. But they dont look swollen as in Rheumatoid. It may be a treatment modified due to use of Saaz and Omnacortil. But yes definitely puffy. Fibromyalgia is more of a diagnosis after excluding all other causes. It is bound to happen in patients with long standing illness. The management is usually with duloxitine or amitryptilline. It is a pain modulator and will improve her sleep quality as well
4. Paracetamol you can use for long duration intermittently. Any medication, no matter how safe can cause side effects in the long run. Osicare is just a supportive medication. You can take it for an year or so and stop it. It does have a bit of placebo effect as well.
5,6,7,. MEthotrexate and Sazo are both used for rheumatoid arthritis. They are both safe for the patient and in diabetes as well. All the studies and everywhere in the world has shows methotrexate to be superior to Sazo in controlling rheumatoid arthritis. The only difference is mechanism of action and efficacy. But yes with methotrexate, a bit more monitoring of liver function tests is needed. Long run it is a well tolerated drug.
But i will suggest you ask your physician to prescribe you the drug as it is a chemotherapeutic drug and we cant give online prescription for it. It is a once a week dosing, but just discuss it with your physician. As for safety wise, our patients take it for years together without much issues.
I hope the information has been useful. YOu can post a query with my name on it for further consultation. The moderators direct it to the doctors concerned.
It s good to meet a caring son. :)
Do take care. WIsh your mother a healthy life ahead
Let me know for further queries
REgards
DR Naval
Treatment for Rheumatoid ARthritis
Detailed Answer:
Good evening XXXXXXX
Sorry for late reply. Was caught up with the duty
As per your queries:
2. The tests results are negative for Rheumatoid Arthritis. RF and Anti CCP are negative and ANA is inconclusive as well. It can still be seronegative Rheumatoid Arthritis but as mentioned earlier, one needs to examine the patient before labeling it as Rheumatoid Arthritis. CRP is mildly elevated, but then again it can be raised in any infection as well. Xray is suggestive of Osteoarthritis than Rheumatoid Arthritis. So all in all, clinical examination is the key.
3. I have seen the hand pictures. They do look quite puffy. But they dont look swollen as in Rheumatoid. It may be a treatment modified due to use of Saaz and Omnacortil. But yes definitely puffy. Fibromyalgia is more of a diagnosis after excluding all other causes. It is bound to happen in patients with long standing illness. The management is usually with duloxitine or amitryptilline. It is a pain modulator and will improve her sleep quality as well
4. Paracetamol you can use for long duration intermittently. Any medication, no matter how safe can cause side effects in the long run. Osicare is just a supportive medication. You can take it for an year or so and stop it. It does have a bit of placebo effect as well.
5,6,7,. MEthotrexate and Sazo are both used for rheumatoid arthritis. They are both safe for the patient and in diabetes as well. All the studies and everywhere in the world has shows methotrexate to be superior to Sazo in controlling rheumatoid arthritis. The only difference is mechanism of action and efficacy. But yes with methotrexate, a bit more monitoring of liver function tests is needed. Long run it is a well tolerated drug.
But i will suggest you ask your physician to prescribe you the drug as it is a chemotherapeutic drug and we cant give online prescription for it. It is a once a week dosing, but just discuss it with your physician. As for safety wise, our patients take it for years together without much issues.
I hope the information has been useful. YOu can post a query with my name on it for further consultation. The moderators direct it to the doctors concerned.
It s good to meet a caring son. :)
Do take care. WIsh your mother a healthy life ahead
Let me know for further 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. Vinay Bhardwaj
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