### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I was diagnosed with Wegeners disease 2 weeks ago after being in remission for about 4 months. They just startedme on Cytoxan which I am to start tomorrow, and  My doctorhas prescribed intravenous Rituxan to be started next week. I am allergic to prednisone. Is there a different med to take in its place? I read all the side effects for Vatican and Rituxan.  Also, what are granulomas?? Should I be havinga second opinion as far as these drugs that have been prescribed.  I am 59 years old and the anca is 1_640.Thank you

### output:

Hello there! 4 months of remission followed by recurrence shows you were not compliant with Ottoman and steroids and Rituxan. Did u take all 4 doses weekly for a month of rituximab? What every past is past now that you have been started on these three meds I recommend taking them as prescribed and chances are your disease will go back to remission 90- 95 %. It would have been better if you had stated the stage of the disease whether it is Localized, early symptomatic, generalized, or severe, or refractory. We call the disease severe when the creatinine levels rise more than 5.6 and generalized when a vital organ like kidney etc. are involved. .minimize your exposure to ill contacts as you are immunosuppressed. And your prednisone issue yes you can replace it with methyl prednisone IV 0.5 mg /kg/day.there are some other treatment addition too for the comorbidities like deadly pneumonitis pneumonia a complication of immunosuppression. For that Trimethoprim-sulfamethoxazole thrice a day to be used for at lest six months after last dose of rituximab. And Plasma exchange is also used it the disease is severe that is great level >5.6 and disease is deteriorating. And METHOTREXATE can also be used if the disease is localized or less severe 20-25 mg per week, but it takes longer to reach remission with it.Ivies intravenous immunoglobulins, mycophenolate moieties (2g/day), evanescent, infliximab, 15-de oxyspergualin, antithrombocyte globulin, alemtuzumabs, abatements and stem cell transplants are some other treatment option but costly .let sum arise To induce remission you needcyclophosphamiderituximabPneumocystic TMP-SMZ prophylaxis glucocorticoidsmethotrexate (if local)To maintain remission you will needAzathioprinemethotrexate leflunamideglucocorticoidsI wish you good luck and get well soon. Regards Chat Doctor. 