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?



Welcome to

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.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
Arthritis with Common Variable Immunodeficiency

What Is Arthritis ... Pain and swelling in one or more joints can occur due to arthritis ...   Read full

Viral Arthritis - Causes, Clinical Diagnosis, Investigations, and Treatment

What Is Viral Arthritis ... Viral arthritis is the swelling or inflammation of one or more joints caused by a viral infection ...   Read full

What can cause knee pain with swelling?

I have ASO titer 800 IU/mL and I do not have any tiredness, headache, fever, history of jaundice, joint pain, etc ... I have knee pain in both the legs and it is pai...   Read full


Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

Listeriosis - Causes, Symptoms, Diagnosis, Treatment, and Prevention
Listeriosis is a bacterial infection, that can result in severe complications like meningitis, sepsis, and even death. R...  Read more»
Myositis - Types, Symptoms, Causes, Treatment, and Prognosis
The term "myositis" refers to a set of uncommon diseases. To know more about myositis, read the full article below.  Read more»
Osteoporosis: an Important Public Health Problem
Osteoporosis is a problem that is largely preventable. This article focuses on the causes of osteoporosis and the availa...  Read more»

Ask your health query to a doctor online?

Ask a Rheumatologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.