Why do I have stiffness despite taking RA medications?

Question

Hello doctor,

I am 42 and was diagnosed with rheumatoid arthritis last year. I have been on Methotrexate 15 mg weekly and folic acid, but still have early morning stiffness and swollen finger joints. My ESR is 42 and CRP is 28 in the latest tests.

So my questions are-

Should I ask my rheumatologist about adding biologics like Adalimumab or increasing the Methotrexate dose first?
Also, are there long-term risks like liver damage or lung problems from staying on these medications for years?
Does regular exercise and physiotherapy really improve stiffness in RA, or is joint damage inevitable even if we control inflammation properly with strong medications?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your persistent stiffness, swollen joints, and raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) suggest that your rheumatoid arthritis remains active despite being on Methotrexate 15 milligrams weekly.

In such cases, rheumatologists often consider increasing the Methotrexate dose to 20 to 25 milligrams weekly (sometimes switching to subcutaneous injections for better absorption) before moving on to biologic medicines like Adalimumab, unless there are specific concerns or evidence of rapid disease progression.

Long-term Methotrexate use can occasionally cause side effects such as liver toxicity, lung problems, or bone marrow suppression. This is why regular monitoring with blood tests and, when needed, imaging is essential. Biologic medicines are highly effective but carry an increased risk of infections, so screening for tuberculosis (TB) and hepatitis is always recommended before starting them.

The encouraging news is that with timely and effective treatment, progressive joint damage can be slowed or even prevented; it is not inevitable. Regular exercise and physiotherapy are valuable alongside medication, as they help reduce stiffness, maintain flexibility, strengthen muscles, and reduce fatigue.

The best next step would be to discuss with your rheumatologist whether adjusting your Methotrexate dose or adding another disease-modifying antirheumatic drug (DMARD) or a biologic medicine is most appropriate for you at this stage, while also continuing physiotherapy and healthy lifestyle measures for long-term joint protection.

I hope this helps you.

Always feel free to reach out at any time. I am always here to help.

Thank you.