Q: My wife is 35 years old and has been diagnosed with S.L.E. major which has affected her fingers of both hands. The fingers are freezed and she is not able to hold anything with her hands. Since two & half years she is under the care of Rheumatologist (Dr.S.N.Amin,Mumbai). Earlier she had been prescribed Prednisolone 60 mg a day for initial 3 months and then it was tapered to 10 mg a day along with physiotherapy. No major improvement was found. Since last three months she is being given Cyclophosphamide 1 gram per month I.V. with 10 mg Prednisolone & calcium supplements. At present she finds herself very nervous is unable to walk on her own. As per the doctor, it is the a long-term side effect of Cyclophospamide. My question is whether this side effect is continous/permanent or is it transient? Will she survive? For the last five months she is on 1 gram cyclophosphamide I.V., is the dose o.k. or shall we stop taking Cyclophosphamide now? She has already received 3 grams. Kindly help and suggest a better option.

A:There is a group of rather difficult-to-treat diseases of young women called connective tissue diseases. SLE is one of them. The symptoms of freezed fingers is more often seen in a sister disease to SLE called systemic sclerosis. Therefore, the first question is whether the patient has SLE or systemic sclerosis. This is possible simply by proper patient examination and appropriate history taking. Regarding cyclophosphamide, it is a double-edged sword. On the one hand it is life-saving for those who have kidney or brain involvement and severe lung disease in connective tissue diseases. On the other hand, it is a toxic drug that can cause sterility and other adverse effects. Only a detailed assessment of the severity and the extent of the organ involvement and balancing it against the good and bad effect of the drug that the treating doctor decides on its administration. Recently, several other drugs have become available that can be used if Cyclophosphamide cannot be used.