instruction: hello doctor I am a 47 year old female I started to have severe joint pains and inflammation around three weeks back then one day as I was giving a presentation my team members noticed that I was bleeding profusely from my nose the in house nurse was called and I was found with high pressure of 210 120 mhg and was subsequently hospitalized for a day after extensive blood tests I was found that my anca mpo anca is 202 u my and anca pr3 anca is 40 74 my what does this mean I was prescribed imuran 50 my once a day
output: hi I have gone through your query I need to clear a few doubts before giving you the final answer I understand you had some problem which started three weeks back with joint pains followed by high blood pressure causing a nose bleed I would like to investigate why you had sudden blood pressure rise is it due to inflammation in the kidneys or some other reason if previously things were normal do you have any history of fever recurrent nose blocks or hearing loss were the other blood tests done like cop reactive protein urine routine chest ray ear erythrocyte sedimentation rate as per the results these are the markers for vasculitis so we need to be sure these are the ones that are causing your joint pains or high blood pressure because the management will change if there is renal involvement and imuran alone would not be enough cop ear urine routine x ray chest pa postero anterior view abc complete blood count let liver function test and serum creatinine