since 2022 this child has presented primarily with significant joint pain and swelling (JIA) both small and large joints. requiring multiple admissions for same. then MIS-C has been on a myriad of biologics starting with Anakinra, Tocilizumab, methotrexate, tofacitnib (xeljanz), IVIG, Humira, Rinvoq, Orencia, currently Orencia, cortes, rinvoq, oropred.!!! naproxen pen, iron supplementation.
elevated markers include ESR, ferritin, IL-18, fibrinogen, CXCL-9, some of the highest readings I have ever seen. including anemia with low mcv,mchc,mch. (also iatrogenic cushingoid)
parents are considering alternatives like Trudose or EBOO both of which we offer but I could use some suggestions on how to start an evaluation and maybe some gut cleaning before even considering or suggesting anything! Maybe over my head!