Arthritis Medications: Managing Symptoms and Side Effects

Arthritis medications

I have been under follow-up in the rheumatology and immunology department for a year and a half.
Previously, I was not on any medication, but my erythrocyte sedimentation rate (ESR) for 2 hours and 1 hour has consistently been elevated, with values ranging from 30 to 60.
Here are my lab results from October 9, 2021:
- ESR (60 minutes): 50
- ESR (2 hours): 20
- Hematocrit: 34.7
- Hemoglobin: 11.8
- Lymphocytes: 24
- Mean Corpuscular Hemoglobin (MCH): 28
- Mean Corpuscular Hemoglobin Concentration (MCHC): 34
- Mean Corpuscular Volume (MCV): 82.2
- Monocytes: 8
- Platelets (PLT): 251
- Red Blood Cells (RBC): 4.22
- Segmented Neutrophils (Seg): 68
- White Blood Cells (WBC): 6.72
- Hematocrit (HcT): 34.7
- Hemoglobin (Hgb): 11.8
- Lymphocytes: 24
After two weeks of blood tests, the results were similar.
My immunoglobulin tests sometimes pass and sometimes fail.
The doctor could not specify which autoimmune disease I might have, only indicating that there is inflammation, as I received the diagnosis a week later.
I have some questions:
1.
I have been taking Xindong Chuangning and Pfizer's non-steroidal anti-inflammatory medication for two weeks.
My body has been itchy, and I have developed small rashes on my limbs that appear flesh-colored and become red when scratched.
If I scratch, the rash appears; if I don’t, it gradually fades, but it reappears in different areas.
Is this a drug allergy or a side effect of the medication? Can I continue taking it? It has been three weeks, and I still experience itching.
2.
Do I really have an autoimmune disease?

Liu Xiaojie, 40~49 year old female. Ask Date: 2021/10/21

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Based on your question, my response is as follows:
1.
Your symptoms resemble urticaria, which may be a side effect of medication; both the anti-inflammatory or pain relief medications could be potential culprits.
Urticaria is generally a mild side effect, and taking a little antihistamine may help improve the condition.
It would be advisable to consider an earlier follow-up appointment with your attending physician.
2.
In the early stages of autoimmune diseases, it can still be challenging to classify them based on symptoms and test results.
Some physicians may choose to monitor the situation, while others may opt to initiate treatment sooner.
If you are genuinely concerned, I recommend discussing with your physician whether it is possible to avoid medication and instead have regular follow-ups for monitoring.
There are some concerns that, if not communicated, your physician may not be aware of.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2021/10/21

More Info

Understanding arthritis medications and their management is crucial for individuals experiencing symptoms related to autoimmune diseases. Based on your description, it appears that you have been under the care of a rheumatologist for about a year and a half, with elevated erythrocyte sedimentation rates (ESR) indicating inflammation. Your lab results suggest ongoing inflammation, but the specific autoimmune condition remains undiagnosed.

1. Medication Side Effects and Allergies
You mentioned taking 信東瘡寧 (likely a form of methotrexate or a similar medication) and 輝瑞非類固消炎藥 (possibly a non-steroidal anti-inflammatory drug, or NSAID). The symptoms you describe—itching, rashes, and skin reactions—could be indicative of either a drug allergy or side effects from the medications.
- Drug Allergy vs. Side Effects:
- Allergic Reactions: These can manifest as hives, rashes, or itching, and they typically occur shortly after taking the medication. If the rash is widespread and accompanied by other symptoms like swelling or difficulty breathing, it could indicate a serious allergic reaction, requiring immediate medical attention.

- Side Effects: Common side effects of NSAIDs include gastrointestinal discomfort, dizziness, and skin reactions. The fact that the rash appears in different places and resolves after some time suggests it may be a side effect rather than a true allergic reaction, especially if it does not worsen with continued use.

Given that you have been experiencing these symptoms for three weeks, it is essential to consult your healthcare provider. They may recommend discontinuing the medication temporarily to see if the symptoms resolve, or they might suggest an alternative treatment plan.

2. Autoimmune Disease Diagnosis
Your concern about having an autoimmune disease is valid, especially with the elevated ESR levels indicating inflammation. Autoimmune diseases can be complex and often require a combination of clinical evaluation, laboratory tests, and sometimes imaging studies to diagnose accurately.
- Common Autoimmune Conditions: Conditions like rheumatoid arthritis, lupus, and psoriatic arthritis can present with joint pain, fatigue, and elevated inflammatory markers. The fact that your doctor has not provided a definitive diagnosis may be due to the overlapping symptoms of various autoimmune diseases and the need for further testing or monitoring over time.

- Next Steps: It may be beneficial to discuss with your doctor the possibility of additional tests, such as specific autoantibody panels (like ANA, anti-dsDNA, or rheumatoid factor) that can help clarify your diagnosis. Regular monitoring of your symptoms and lab results will also be crucial in managing your condition.

Conclusion
In summary, the symptoms you are experiencing could be related to medication side effects or an allergic reaction, and it is essential to communicate these concerns with your healthcare provider. Additionally, while the presence of inflammation and elevated ESR levels suggests an underlying issue, a definitive diagnosis may require further investigation. It is important to maintain open communication with your rheumatologist and follow their recommendations for managing your symptoms and adjusting your treatment plan as necessary.
Always prioritize your health and seek immediate medical attention if you experience severe reactions or if your symptoms worsen.

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