Question about Maintenance

[Middlesista]

I came across two recent articles that might be of wider interest, that describe current knowledge/thinking/trials about various treatments for inducing and maintaining remission.

https://www.dovepress.com/place-in-t...xt-article-ITT

SMW - Swiss Medical Weekly -*The role of rituximab in the treatment of ANCA-associated vasculitides (AAV)

Thanks so much Max for posting these links - great info and the bottom line it seems for me is



6. RTX can be used as maintenance therapy as an alternative to azathioprine or MTX. The best treatment regimen will need to be defined as suggested strategies vary widely.

What I need to learn is why in my case MTX was chosen- I read that the azathioprine was considered safer than MTX.

[Middlesista]

I can't directly answer your question as to your absence of B cells, and I don't take RTX, but only MTX....however, I do know there are people on here who have taken both at the same time, for extended periods, and don't think there is a problem with it. But I don't blame you for being concerned about taking more immunosuppressants than you need. If you follow this regimen for a month, until you can see the doc at MGH for a second opinion, I don't think you'd have lost much, if anything. I hope someone on here who has taken both together will shed some light.

Thanks Anne- it is comforting to know that others have taken both and that you have been on MTX sucessfully pretty much also

[Middlesista]

Hi sister. I think that the losec it to protect your stomach from the pred.
as for mtx and rtx together, they love that combination. my wg dr. also wanted me to stay on both even though mtx did nothing to me. not a bad feeling as well. just nothing. he explained that this is the better combination for treatment. no idea why. I asked to stop mtx because I had too many infections and after I stopped it, the infections became less frequent. if you want to know if your body can fight infections you need to check your Igg. I check mine every 4 months or so and they are normal.

Thanks Alysia - will ask RA to make sure these labs are done

Hope you are feeling a little better. ��

[vdub]

Alysia, Do you know if the IgG is also called Gobulin? I went back through my blood tests and I see Gobulin and ALB/Gobl results, but no IgG. I hadn't paid much attention to it, but will now.

While trying to find the answer myself, I read this interesting comment on Globulin Levels | MD-Health.com

"Hypothyroidism can also alter the levels of globulin in the system, as can glucocorticoid, which can be caused by a tumor that releases cortisol-mimicking compounds, an overactive adrenal gland or excessive use of cortisone or cortisone-mimicking medications."

The part that caught my attention was "cortisol-mimicking medications". My replacement drug for cortisol is hydrocortisone, a weaker form of pred. And, of course, a lot of us are on pred as a matter of routine. It opens up a lot of questions that could be a separate topic all its own. Good comment Alysia.

[MaxD]

IgG, IgA, IgM are three indicators in the Immunoglobulin test panel - this test is ordered in addition to the standard CBC, ANCA, ...

[Alysia]

Alysia, Do you know if the IgG is also called Gobulin? I went back through my blood tests and I see Gobulin and ALB/Gobl results, but no IgG. I hadn't paid much attention to it, but will now.

While trying to find the answer myself, I read this interesting comment on Globulin Levels | MD-Health.com

"Hypothyroidism can also alter the levels of globulin in the system, as can glucocorticoid, which can be caused by a tumor that releases cortisol-mimicking compounds, an overactive adrenal gland or excessive use of cortisone or cortisone-mimicking medications."

The part that caught my attention was "cortisol-mimicking medications". My replacement drug for cortisol is hydrocortisone, a weaker form of pred. And, of course, a lot of us are on pred as a matter of routine. It opens up a lot of questions that could be a separate topic all its own. Good comment Alysia.

Thanks vdub. if I understand correctly then the immunogloubulins are one kind of globulins. the gamma globulin. there are also alpha and beta.
I don't know much about this, just what I learned when I was with my sweet Phil at the hospital. we wanted to know if he is able to fight the infections that he got in the lungs when he was at the ICU. his Igg came back zero ! means that his immune system couldn't fight at all. prob because of pred and rtx and all that sickness. they gave him IVig. the day after, his Igg came back normal. they continue to check it and when it was getting under the normal again, they gave him another IVig.
the info that we collected at that time is in this thread on pages 14-16 http://www.wegeners-granulomatosis.c...thread-15.html
excellent post about this issue is on page 15, post number 143 of me2.

in short, you can check it and if its under the normal then you might need IVig. mine are always normal so far.