How does the dosage of Methotrexate vary for treating RA?

Question

Hello doctor,

My 68-year-old mother was diagnosed with rheumatoid arthritis nine years ago and has been taking Methotrexate since then. She's currently taking 7.5 mg per week, along with daily Folic Acid (5 mg), Calcium (500 mg), HCQS 400, and Pantoprazole. Lately, her pain has been getting worse, especially in her left knee, and she's having more trouble moving around.

Do you think it's time to adjust her Methotrexate dose?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I reviewed your query, and based on what you described, it sounds like your mother's medications may need to be adjusted, especially since her joint pain is getting worse. Her lab reports show a high ESR (erythrocyte sedimentation rate) of 71 mm/hr, which typically points to significant inflammation.

Here are a few thoughts on her current medications:

Methotrexate – The standard starting dose is usually around 15 mg once a week. A dose of 7.5 mg may be too low to effectively control her symptoms. If she is tolerating it well with no side effects, there is definitely room to increase the dose.
HCQS (Hydroxychloroquine) – Long-term use of 400 mg daily can potentially affect eye health. It would be safer to lower the dose to 200 mg per day, especially at her age.

That said, an in-person evaluation is always ideal. It allows us to better assess which joints are swollen, how severe the inflammation is, and how much she might benefit from adjusting her treatment plan.

Wishing her relief and better days ahead.

I hope this clarifies your questions. Please reach out again if you need further guidance or have additional concerns.

Thank you.