I am 39, with RA. What causes swelling despite treatment?

Question

Hi doctor,

I am 39 years old and was diagnosed with rheumatoid arthritis four months ago. My RF is 112 IU/mL, anti-CCP 280 U/mL, and ESR 62 mm/hr. I am on Methotrexate 15 mg weekly with Folic acid, but I still have swelling in my wrists and knees.

Does this mean the treatment is not working, and should I consider switching to biologics?
My CRP is 24 mg/L, and ALT is slightly high at 61 U/L is Methotrexate causing liver strain?
Would diet changes such as avoiding dairy and gluten actually improve symptoms, or is it just a myth?
Does exercise help or worsen joint damage?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed your query and understand your concern.

Your test results show that your rheumatoid arthritis is still quite active despite being on Methotrexate for four months, which is not uncommon since Methotrexate sometimes takes longer to fully work and may need dose adjustment or combination with other disease-modifying drugs before moving to biologics.

The elevated CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate), along with persistent swelling, suggest ongoing inflammation. Your rheumatologist may consider increasing Methotrexate (if tolerated), adding another conventional DMARD (disease-modifying antirheumatic drug) (like Leflunomide or Sulfasalazine), or moving to a biologic if disease control remains poor.

The mild alanine aminotransferase (ALT) elevation could be due to Methotrexate, so your doctor will likely continue to monitor your liver function closely and may adjust the dose or add folate supplementation.

Dietary changes such as avoiding gluten or dairy have no consistent scientific evidence of improving rheumatoid arthritis, though some patients notice reduced bloating or general inflammation with a balanced anti-inflammatory diet rich in fruits, vegetables, Omega-3s, and limited processed foods.

Exercise, particularly low-impact activities like swimming, yoga, or walking, is strongly encouraged. It improves joint flexibility, reduces fatigue, and helps prevent stiffness without worsening joint damage, as long as you avoid high-impact stress during active flares.

I hope this information helps.

Thank you.