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Suggest treatment for seronegative arthritis

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Posted on Wed, 14 Jan 2015
Question: Hi Sir,

My fiance is having symptoms of seronegative arthritis her age is 25 years she is suffering pain in knee from last 1 month. consulting doctors are suggesting to have methotrexate and methylprednisolone, is it safe to take it? and how long it will take to completely recover from it.

here are various test result performed on her
RA test - negative
ASO test - negative
VDRL - non reactive
Uric acid - 3.0 mg/DL

Urine analysis
Quantity - 20 ml
color - pale yellow
clearity - clear

sugar - nil
albumin - nil
epithelial cells - 2-3/hpf
PUS Cells - 2-4/hpf
RBCs - 10-12/hpf
cast - NIL
Crystal - NIL
mucus thread -Present
RBS - 81 MG/dl
Blood urea - 27 Mg/DL
Serum calcium - 8.2 Mg/dl

Haematology result:
Total WBC count - 10.6 GM/DL
Diff WBC Count - 6800 cells/CU/MM
Neutrophils - 63%
Lymphocyte - 26 %
Monocyte -02%
Eosinophils -09%
Basophils - 00%

ESR 50 mm the end of 1st hour

Thanks
doctor
Answered by Dr. Naval Mendiratta (41 minutes later)
Brief Answer:
is it seronegative arthritis

Detailed Answer:
Good evening XXXXXXX

Thank for writing on health care magic

Well i have gone through your history and reports mentioned. The only abnormality i found here was raised ESR.

As per your query, well the drugs are quite safe to take. But in our practice we normally dont give steroids for long. We try to taper it as soon as we can so the patient does not get dependent on it. As for Methotrexate, it is a very safe and effective drug for arthritis. The only problem is her age and the future pregnancy, as this drug needs to be stopped 3 months prior to planning for conception. So before you start you need to consult your doctor about it.

But in the history i have viewed , i do see some loopholes. As you said, it is only the knee pain which affected her and lead to this diagnosis. To label it as seronegative we need to look for ANA and Anti CCP as well. Plus there has to be more joints involved to start this treatment. I would like to rule out a few other causes before starting the treatment:

1. Does she experience dry eyes or dry mouth

2. Any rash over the face or other parts of body

3. Any history of neck pain or backache

4. ANy history of increased hair falls, oral ulcers, cough, shortness of breath

5. ANy history of skin pigmentation

6. Does she experience bluish discoloration of fingers on cold exposure

7. History of weight loss or fever

Do let me know these queries. Would be happy to guide your further

Regards
Dr Naval


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Naval Mendiratta (22 hours later)
Hi Naval Sir,

Thanks for your guidance.

Before answering to your question, I want to bring here few points which can help in diagnosis.
Her problem started suddenly one morning when she reported pain in left hand thumb, which was identified as de-quervain diseases by one of the doctor. As suggested by doctor she started taking up pain killer and physiotherapy courses, after 2-3 weeks when pain and swelling is not reduced and swelling lead to the middle finger of left hand then the doctor suggested to take "methotrexate" tablets and just after taking this tablet for one week she reported pain in her left knee so she stopped taking methotrexate, and after 2 days inflammation on knee happened.

Then she visited to another doctor that asked to perform few test, the result of those test are mentioned in my earlier question. He prescribed to take Vitamin d3 tablet and antibiotic medicine; she also did joint Aspiration to get relief from pain. But Inflammation reoccur in few days and after one week she goes to the doctor for scheduled visit, he told her to do good amount of exercise and only changed the antibiotic.

Now due to our marriage is near and she want to get rid of these pains as soon as possible so she visited to another doctor and he said she has sero-negative arthritis and prescribed methotrexate and methylprednisolone.

Here is answer you are looking for the question
1. Does she experience dry eyes or dry mouth - No
2. Any rash over the face or other parts of body - No
3. Any history of neck pain or backache - Backache present
4. ANy history of increased hair falls, oral ulcers, cough, shortness of breath - Sneezing history present
5. ANy history of skin pigmentation - No
6. Does she experience bluish discoloration of fingers on cold exposure - No
7. History of weight loss or fever - She is already lean and she did not had significant weight loss

She will get ANA and Anti CCP report soon.

Thanks again.
XXXX
doctor
Answered by Dr. Naval Mendiratta (11 hours later)
Brief Answer:
Seronegative Arthritis

Detailed Answer:
Dear XXXXXXX

Thank you for reverting back. Well the history you have suggested does look like arthritis, which is in it s initial phase. History of knee aspiration does give us a strong clue. But yes do let me know about ANA and Anti CCP report as it will confirm if it is really seronegative or not. Either way the treatment doesnt change much

But what you and your fiance need to understand is, the medications are a bit slow acting. She needs to continue methotrexate for a few months before the action begins. It normally takes 6-8 weeks to start affecting. If your marriage is near, the best way to get through is Steroid injections. We give it intramuscular here but if the disease is severe, we even give it intravenous. But yes, it is only for short term till the action of methotrexate takes course as long term steroids come with lot of side effects.

Secondly, You need to be very careful before planning a family if you are on methotrexate. I would recommend you speak to your doctor and maybe start with sulfasalazine as well. So the disease gets better and once u plan for a family, methotrexate can go off and sulfasalazine can continue through the pregnancy.

But yes, you need to be under a Rheumatologist care and monitor her bloods sequentially. These are important issues and one needs to look into it and as a couple it is very essential for you both to understand and deal with the problem.

Dont worry, she will get better and lead a normal life. We just need to streamline her medications

Do let me know for more queries. Would be happy to answer

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Naval Mendiratta

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Practicing since :2007

Answered : 754 Questions

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Suggest treatment for seronegative arthritis

Brief Answer: is it seronegative arthritis Detailed Answer: Good evening XXXXXXX Thank for writing on health care magic Well i have gone through your history and reports mentioned. The only abnormality i found here was raised ESR. As per your query, well the drugs are quite safe to take. But in our practice we normally dont give steroids for long. We try to taper it as soon as we can so the patient does not get dependent on it. As for Methotrexate, it is a very safe and effective drug for arthritis. The only problem is her age and the future pregnancy, as this drug needs to be stopped 3 months prior to planning for conception. So before you start you need to consult your doctor about it. But in the history i have viewed , i do see some loopholes. As you said, it is only the knee pain which affected her and lead to this diagnosis. To label it as seronegative we need to look for ANA and Anti CCP as well. Plus there has to be more joints involved to start this treatment. I would like to rule out a few other causes before starting the treatment: 1. Does she experience dry eyes or dry mouth 2. Any rash over the face or other parts of body 3. Any history of neck pain or backache 4. ANy history of increased hair falls, oral ulcers, cough, shortness of breath 5. ANy history of skin pigmentation 6. Does she experience bluish discoloration of fingers on cold exposure 7. History of weight loss or fever Do let me know these queries. Would be happy to guide your further Regards Dr Naval