Q. I have pain due to RA in spite of taking medicines. Please tell me what I can do.

Answered by
Dr. Ashaq Hussain Parrey
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 18, 2017 and last reviewed on: Oct 09, 2018

Hello doctor,

I was diagnosed with RA two years back and I am taking treatment for the same. My left knee is affected badly and the swelling is not coming down. Initially, I was not able to walk, but now I can walk slowly but cannot climb the staircase or fold my left leg completely. Recently I am getting a pain in my left wrist as well. I have attached the files.



Welcome to icliniq.com.

I went through your post and have seen the reports (attachment removed to protect patient identity). Your rheumatoid arthritis is not controlled which is evident from your high ESR (erythrocyte sedimentation rate) of 60. The reason for this is that you are not adequately treated.

  • Rheumatoid arthritis is treated by starting two DMARDs (disease-modifying antirheumatic drug) as follows.
  1. Methotrexate is started as a 10 mg weekly dose and increased to a maximum of 25 mg weekly. For you, I would advise 15 mg weekly. You can pick a day of the week, for example, Sunday, and take it every week on the same day. On Monday, you could take Folic acid 10 mg. 
  2. Start Hydroxychloroquine Sulfate (HCQS) 300 mg once daily.
  • You can take a low dose Prednisolone 5 mg once a day in addition to Calcium and PPI (proton-pump inhibitor).
  • For the knee problem, you can take an intra-articular Triamcinolone 60 mg into the knee joint. That will control your symptoms till your disease gets controlled. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent.


For more information consult a rheumatologist online --> https://icliniq.com./ask-a-doctor-online/rheumatologist

Hello doctor,

Thanks for the revert. My ESR last year was 75, and before that, it was 120. I wanted to know if my RA is in an aggressive state. Also, I am taking 500 mg Sazo (Sulfasalazine) daily. Is it alright to take 15 mg of Methotrexate? For how many days should I take it? I was advised to take 10 mg for three months but I am taking 7.5 mg. Also, I am attaching my previous reports.



Welcome back to icliniq.com.

  • Sazo (Sulfasalazine) is a second line drug and its dose is 1000 to 1500 mg twice daily and not 500 mg. Hydroxychloroquine 300 once a day would be a better alternative.
  • Methotrexate 15 mg is to be taken only once a week. If needed, it can be increased up to a maximum dose of 25 mg.

For more information consult a rheumatologist online --> https://icliniq.com./ask-a-doctor-online/rheumatologist

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