Which medication should be taken to cure joint pain?

Hello doctor,

I am a 36-year-old, male, height 160 cm, and weight 52 kg. I am suffering from an autoimmune disease, for the last 20 years. 13 years ago, I took Methotrexate 7.5 mg to 12.5 mg and got fully recovered. Later again 10 years back I got the same issue, and the same doctor prescribed Sulfasalazine 500 mg for one month. Since then I was very well for the last five years but now I again got pain. I took Sulfasalazine 500 mg for one week one tablet, the second week two tablets upto fourth week four tablets. But only partially I recovered with one month gap, where I took kidney and liver tests that came back normal. But the infection or inflammation rate shows as 46 % in the blood test. My question is in the first month I took Sulfasalazine 500 mg and in the second month I waited for the tablet to work. In the third month, I took Methotrexate 12.5 mg per week and now I fourth week got completed. The pain in my joints is now double the time that it was in my first month. Should I continue to take Sulfasalazine again as one more course? Or will I have to wait and continue with Methotrexate for two more weeks?

Hello doctor,

It is a follow-up consultation on your previous medication, I took your medications for 10 days as per your instructions. Now I have completed six weeks of Methotrexate (5 weeks of 12.5 mg and 1 week of 15 mg). Now tomorrow onwards 7th week. I got a very tiny little relief but I do not see big relief in pain and swelling. Still struggling to sit and stand without the help of others, even waking up in bed and going to the bathroom. Taking Diclofenac 50 mg twice a time daily. Should I continue taking Methotrexate or shall I stop and wait for relief in the upcoming week? And I am waiting to follow up on your consultation.

Hello doctor,

I have had severe pain after stopping Diclofenac. I am continuing to take the other medication as per your instructions. Today am entering the 8th week of taking methotrexate. When should I start taking Leflunomide 10 mg?

Hi doctor,

Now, I feel better. There is reduced swelling and 20 % of my pain has reduced. Now, I can go to the bathroom by myself. Thank you for your help. Still, major pain persists in my left hip pelvic joint and in both shoulders. Due to this, I am limping heavily while walking and I cannot raise both of my hands and I am struggling to lift the water bottle. Also, I have problems with the left-hand elbow, both knees, the left boot of the foot, and the fingers of the foot. I have swelling and pain in all the places.

Today, I am taking my 10th week of Methotrexate 15 mg. In the morning, I take Diclofenac and at night, I take Methylprednisolone 4 mg, along with Leflunomide 20 mg in the morning alone. Also, I take Hydroxychloroquine 200 mg twice a day. Today onwards, I decided to stop taking Diclofenac. I repeated the same C- C-reactive protein test and it reduced from 46 % to 16.9 %. Ultrasonography of my abdomen and pelvis are all normal. For your reference, kindly check the attachment. How long should I take these medicines before my next follow-up? Kindly help.

Hello doctor,

I stopped taking the tablet Diclofenac for more than two weeks till today, though I still have heavy pain and swelling. Due to a family problem, my wife threw away all my tablets. I was supposed to take the tablet Methotrexate 15 mg yesterday along with Leflunomide 20 mg, Methylprednisolone 2 mg, and Hydroxychloroquine 200 mg but it will take at least two days to get all the tablets back. I would like to clarify two things. You said that Methotrexate will take about six weeks to three months to start acting. But now, I have completed almost four months of taking Methotrexate. Why is it not working?

I am in severe pain and depression due to lack of income and taking bed rest. I do not know what to do since I lost my reputation and respect. I feel hopeless. I cannot understand what went wrong. With the same tablet that I took 12 years back, I got cured perfectly but I do not understand why my body is not responding now. Should I follow any diet control? Is it okay to continue taking all medicines after two days? Should I need to take any other test? Kindly suggest.

Thank you.

Hi doctor,

Yes, I do not have pain alone, but my joints are swollen and are paining severely. Totally, I have swelling and pain in 14 of my joints which are as follows:

1. Left and right shoulder and elbow.
2. Right back side ribs and lower back muscle.
3. Left hip joint.
4. Both knees.
5. Left ankle.
6. Left toe.
7. The feet in the legs.

I cannot sit in a chair for not more than 15 minutes. I cannot walk a single step without a walking stick. I am waiting for the time when at least I can wear my clothes by myself. I will continue to take the medication as you prescribed and hope I will get well soon.

Thank you.

Hi doctor,

I am following all the medications as per your instructions:

1. Morning- Leflunomide 20 mg.
2. Night- Methylprednisolone 4 mg + Tofacitinib 5 mg.
3. Methotrexate 15 mg (weekly once).

Now I feel much better and have great relief as well. However, the pain in my left pelvic hip joint and left elbow joint pain still persists. I have attached the results of ESR, CRP, and CBC as well for your reference. I am waiting for your further instructions.

Hi doctor,

I have great relief now. Thank you so much for your guidance. As per your instruction, I have repeated the same test and have attached the reports for your reference. Now, I have got a job offer in an abroad country and have to join the work within two months. Meanwhile, before leaving, I am planning for a second baby. Will there be any side effects, or can I proceed with planning my second baby? Kindly suggest.

Hello doctor,

I have attached the reports. Should I continue taking the tablets? And also, I am planning for a second baby. Is it advisable? Kindly suggest.