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Q. Can the Methotrexate dose be increased if a rheumatoid arthritis patient has an increase in pain?

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 18, 2022 and last reviewed on: Sep 29, 2022

Hello doctor,

My 68-year-old mother was diagnosed with rheumatoid arthritis nine years ago and has been on Methotrexate since then. She has difficulty moving limbs, and her left knee joint aches a lot. Currently, the dosage of Methotrexate is 7.5 mg per week, Folic acid 5 mg daily, Calcium 500 mg daily, HCQS-400 daily, and Pantoprazole once daily. Now her pain is increasing, so should the Methotrexate dose be increased?

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Hello,

Welcome to icliniq.com.

I have gone through your query. As such, the medicines need modification for her if the joint pain is increasing. The reports show a very high ESR (erythrocyte sedimentation rate) of 71 mm/hour, which may indicate inflammation inside. As for the medicines:

1. Methotrexate: We normally start at 15 mg once a week since 7.5 mg serves very less to control the pain. So there is a scope for increasing it provided she tolerates it and does not experience any side effects.

2. HCQS (Hydroxychloroquine) should be lowered to 200 mg daily as 400 mg for a long time can be a little harmful to her eyes.

But yes, we always prefer an examination in person to be sure why the pain is happening, which joints are swollen, and how much improvement she will be experiencing after increasing the dose.

Thank you.


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