Conversation: The conversation between human and AI assistant.
[|Human|] My son at the age of 4 was diagnosed with jra and was started with naproxen,methotrexate,and sulfasalazine. But then at 8 he was taking off sulfasalazine and now takes enbrel and folic acid. But when I take him to get seen the Dr just visual checks him I do take him for blood work and she says they come out good but now he has been fatigued and easy bruising should I get another opinion? Thaks
[|AI|]  Hello.  Welcome to Ask A Doctor.  I have read your query and here is my advice.  ERA most certainly can cause fatigue, but it does not cause easy bruising. One type of ERA(systemic) is associated with a pink-salmon colored rash all over the body.  Easy bruising can be due to vitamin K deficiency, a reduced number of platelets in blood stream, a different type of hemoglobin than usual in the red blood cells in the blood stream, absence of clotting factors(proteins) in the blood stream, different malignancies, medicines.  You should know more about your sons condition than just his medications.  For instance, eye problems are especially associated with one type of ERA.  From what you have shared, yes, I feel you ought to get a second opinion from a pediatric rheumatologist, please.  He/she will provide you with more information about ERA and inform you if your child needs to be seen by a blood specialist(pediatric hematologist).  Kindly make an appointment as soon as possible.  Hope I have answered your query.  If you have any further questions, I will be happy to help.  Arnold EDD, MD, FLAP