                                                                Rainbow Children's Hospital - Marathahalli
                                                                  Rainbow Children's Hospital - Marathahalli
                Rainbow
                Children's                                   Sy No. 8/5, Marathahali - KR Puram Outer Ring Road
                Hospital                                Doddanekundi, Marthahalli Bangalore Karnataka INDIA 560037


                                                                                  OPD Summary

                                         MAB-00082368                                                          Visit No           040237-849197
             UHIL
                                        Master SYED ARSALAN                                                    Visit Date         02-09-2023
             Patient Name
                                       06-05-2015 / 8 Y 3 M 27 D / Male                                        Consultation       First Visit
            DOB / Age /
                                       Dr. CHANDRIKA S BHAT
            Doctor Name
                                       RHEUMATOLOGY
              apartment

               pecialization
                Chief Complaints :
               Jovenile arthritis
               Myositis
               Non nephrotic range proteinuria
               WES no mutation consistent with his phenotype


               Present Illness :
              Received IV steroids from 23- 25.8.23 after which symptoms resolved
              Recurrence of pain and swelling in right wrist and left knee 2 days later onwards
              Low grade fever spikes
              Repeat CRP after IVMP 25, 12.9/5200/428000. ESR 71. OT/PT 34/40


             Medication History :
            Ini folitrax 10mg s/c once a week (first dose on 6/4), switched to oral (Nov 21), switched to subcut
            in May 22- back to oral MTX in Nov 22-)
            Tab folvite 5mg once a week
           Inj exemptia 20mg s/c (14/04-Sept 21) fortnightly, restarted Nov 2021 (last dose given on 5/5).
           discontinued
           MMF for 6 months in 2021
          Rituximab 2 dose in June 2022
          Pulse steroids in May 2023, June 2023, July 2023
         Tab tofacitinib 5mg at night (June 2023-)
           Vitamin D and calcium supplements


          Examination :

          Looks dull
         Arthritis right wrist and left elbow
         Other joints normal
        Muscle power 4/5 in all 4 limbs

        Doctor Recommendations :

       Response to tofacitinib so far has been suboptimal (8 weeks done), suggest waiting for another 4 weeks
       before changing to tocilizumab,
       1. Intra-articular steroid injection to right wrist and left knee today
       Triamcinolone hexacetonide 10mg to right wrist, 20mg to right knee? ER
      Plan to do joint injection at 1pm, inform plCU for sedation
      2. Continue pulse steroids monthly for 2 months
      3 .. Tab tofacitinib 5mg at night to continue
     4. Tab folitrax 10mg once a week to continue
      5. Tab folvite 5mg once a week to continue
     6. Sy septran 2.5ml twice a day on Mon/Wed/Fri
     7. Cholecalciferol 600001U once in 2 weeks to continue

istered Office: 8-2-120/103/1. Survey No.403, Road No. 2. Bar·ara Hill, Hyderabad 500034, Telangana
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ad On : 02-09-2023 12:17                                                                                                                                          Page 1 of 2

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