Hi every one. I am confused about dose of Azathioprine. My Chest Phys. says reduce the amount but Rheumatologist says not.

[LynneJ]

I have had Microscopic Polyangiitis for about two years which is controlled by 150mg Azathioprine per day, I finished taking steriods last March. I saw my Chest constultant and he was concerned about the size of my red blood cells being above normal and should reduce to 100mg which is the dose he gives. But this morning I received a letter from my Rheumatology Consultant who says she would prefer me not to reduce them and is not concerned about the blood. Who is right? Should I talk to my GP?

[PatriciaAnn]

The Aza can and does affect the blood results, and it is normal to adjust the dose occasionally. Getting conflicting opinions just isn't helpful. I've had this in the past and I contacted the main consultant (my rheumatologist) and he discussed it with the other consultant and came to an agreement. I think that you need some joined up thinking from the consultants. Maybe the approach I took would be helpful. Alternatively perhaps your GP is best placed to contact them both, maybe asking them to liaise so that you know exactly where you stand.

Patricia

[John_Mills Volunteer]

I think it would take a brave GP to intervene in a disagreement between consultants!

(Aza can affect people differently. Some people lack or are deficient in an enzyme called TPMT which means the Aza has a greater effects on the bone marrow, where the blood cells are manufactured.) Folic acid or Vitamin B12 deficiency can cause enlarged RBCs (Iron deficiency can cause reduced size). So it's a complex picture.

Probably best to talk to both consultants to get the full picture and get them to agree on a sensible way forward. You don't want to become anaemic but then you don't want a relapse either. Maybe a change of medication?

[LynneJ Vasculitis UK Volunteer]

Thanks a lot for replying.

I was tested for folic acid and B12 which were OK. They did have a disagreement on the original medication as I started with pulmanary fibrosis (which is why I see the chest consultant) My rheumatologist wanted to give me methatexate which the chest man said could cause fibrosis, which is why I am on Aza. I only see the rheumatologist every 6 months and the last time was a stand in, and see the chest man every 3 which is why I tend to talk to him more.

I will have to be patient until May when my next appointment is. Is nothing straight forward with this condition? Just when you think things are going well something else to worry about!

By the way is this TPMT enzyme diet related?

Thanks again.

I am so glad I found this site as it really helps not to feel so alone.