Rheumy Time

The joint pain has been acting up the past few weeks, and rheumy wasn't surprised based on the high sedimentation rate seen in my blood work. The  Erythrocyte Sedimentation Rate (ESR) test is a blood test used to detect and monitor inflammation in the body. The test measures the rate at which red blood cells (RBC) settle and is measured in millimeters per hour. The sedimentation rate increases with more inflammation. The normal rate 0-15 mm/hr for men and 0-20 mm/hr for women. My latest blood test was 45 mm/hr, but rheumy says that the rate is probably slightly elevated because of my anemia. Even normalized for the anemia, however, it is still high.

The joint pain in my knees was back this past weekend. The pain is so bad that it feels as though I can't even handle the weight of my body. It makes it difficult to sit, stand, and walk. I've finally come to terms with the fact that I may benefit from using a cane when this type of pain acts up.

Rheumy asked me if I had given thought as to the additional drugs we had discussed at the last appointment (azathioprine or methotrexate). I told him that between the two, I was leaning towards azathioprine. Rheumy said that there was one more option, sulfasalazine. The drug is is more often used for arthritis, and since that seems to be my biggest symptom right now, it would help with the inflammation and joint pain. The down side is that it wouldn't help with any of the other lupus symptoms if they came up. If I were to flare and there was other organ involvement, I'd need to start another medication in addition to the sulfasalazine. Also, a huge deterrent for me is that they are huge pills and I may need to take up to six a day.

In the end, I decided to go with the azathioprine. Some of the side effects are stomach pain and nausea, so rheumy suggests waiting until the weekend to start taking the medication (in his words, "you don't want to go out and be throwing up everywhere" -- nice...). We are starting with a very low dose due to the fact that I have a gene that doesn't metabolize the drug properly, so hopefully this decreases the chance of side effects I might experience.

I picked up the medicine from the pharmacy and was relieved to see that the pills are relatively small. Bigger than my prednisone and levotyroxine, but smaller than my hydroxychloroquine. The pharmacist also confirmed that it would be okay to crush or chew the pills.

On the bright side, my blood tests indicate that my kidneys and liver are doing okay. My next visit is in four weeks, so hopefully we'll see some improvement.

- a little lupie -