My wife has been diagnosed as SLE with Rheumatoid arthrits.Was being intially given methatroxate,HCCQ,SAZO,Volteren,.She took methatroxate for few months only as she did not tolrate it.Then predinisolone 10 mg was added to her treat ment.For last few months platelets started falling dowm gradually.But for last one month drop of platelets was quick,but gradual and reached to 43000 only.predinisolone was increased to 60 mg OD.Platelets increased quickly but after few day again started falling quickly and reached to 45000 .Then Methyl predinasolone 30mg 8 hourly was given by IV drip for three days and platelets increased again above one lack and pt.was again shifted to oral predinisolone 50 mg od.In the mean time all side effects of steroid appeared like swelling of face and body,increased appetite, acnae like rash on face and body,genelised lethargy[weakness] ,shortness of breath etc.but after few days platelets again started falling down quickly and reached to 43000 again.Now she has been given immunoglobulins 400mg/kg per day by Iv drip for five days and in the mean time predinisolone was reduced to 10 mg TId [30 mg od] and platelet count has increased to 112000 and pt will be revieweId on saturday again[after 2 days].I forget to mention that in addtion to all investigations Bone marrow was done which suggested the peripheral destruction of platelets[Thrombocytopenia due to SLE peripheral destruction].Steroid were started about one and half month back.She is also being given calcium,Vit.d tabs,Amlodipine 5 mg od from ffor last few months.She was also started azathioprine 50 mg od for last 2-3 days.

Now my question is that was this process and procedure a correct way of treating this problem ? and when will the adverse effects of steroids disappear ? and thirdly what adverse effects are expected from Immunogloblins.Presently she tolrated them well without any advese effects.Yesterday was given the final[5th]dose ? Is adding Azathioprine a correct decision ? Finally it is requested to let me know is there any other safer teatment available for SLE and where[I mean in India] ?

Thank sir.

Dr.Nasir

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