Q: I was diagnosed as a border line case of SLE (ANA - positive, Anti-ds DNA - negative) two years back. Currently I am on Immuron & Predinisolone. I am a mother of two children. I am suffering a heel pain continuously especially early morning when getting off from bed also after walking continuously. How long should I take these medicines? Please advise.
A:Test reports without any clinical history are usually insufficient for making a definitive diagnosis. However, if we take the facts provided by you on their face-value and take it that you have mild form of systemic lupus erythematosus, then the treatment being taken by you would be considered most unusual. Azathioprine and prednisolone is usually given in serious types of systemic lupus erythematosus. For mild SLE the definitive treatment consists of mainly hydroxychloroquine. Prolonged use of prednisolone is now considered unnecessary (or even harmful) unless you have some serious organ involvement that you have failed to mention in your case history. There are several other new compounds including low-dose aspirin, dehydroepiandrosterone, bromocriptine, and moderately high daily dose of folic acid in combination with hydroxychloroquine that are rapidly becoming the mainstay of long-term treatment in SLE. But, definitely not prolonged prednisolone and azathioprine unless there is a clear indication and justification. Heel pain is never a problem related to SLE. The commonest cause of heel pain is calcaneal spur (a bony thorn-like projection in the heel bone) that causes pain in persons who are over weight. Weight reduction, special type of shoe (with a central hole in the heel so that the pressure point gets distributed around the margins of the heel) and sometime, local injection of corticosteroids at the painful site may help in controlling the heel pain.