Q. My RA positive mother has pain with nodules in hand. Please suggest medication.

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 23, 2020

Hello doctor,

My mother is 65 years old. She is RA positive for the last 25 years. Currently, she takes HCQs, Methotrexate, pain killer, and Rantac. At present, she has pain, nodules in hand, and turned feet. Please suggest proper medication. Her LFT and KFT are normal.



Welcome to

I have gone through your query. But the report images could not reveal anything. (attachment removed to protect patient identity).

I would like to ask you a few more queries before suggesting the medicine as any new DMARD (disease-modifying antirheumatic drug) started has to be taken with caution.

You mentioned pain, is it in the joints or the whole body? Is there dryness of eyes or mouth? Is the sleep normal or disturbed? Any forgetfulness? Irritability? When is the pattern of pain more, mornings after waking or constant throughout? Please message me the dose of Folitrax as well which she is taking and the name of the pain killer? Do you have the last ESR (erythrocyte sedimentation rate) and CRP (c-reactive protein)? Is she taking calcium and Vitamin D supplement?

I understand she has an aggressive disease considering nodules, deformities persisting. But lot of times people with long-standing arthritis develop secondary fibromyalgia and the management is very different. We can only be 100 percent sure after clinical examination but will help you in the best possible way we can.

Try to reattach the reports as well.

Thank you doctor,

Tablet Folitrax 7.5 mg once a week following by folic acid on the rest day. Did you feel HCQs BD and Folitrax are not working in the body? CRP has done six months back and it was very high. One doctor recommended steroids on a decrease basis.



Welcome back to

Yes, if the CRP was very high and she has persistent pain, swellings then we should alter the dosing. I would suggest you repeat ESR and CRP once to be sure how much the inflammation is.

Firstly, the dose of Folitrax (Methotrexate) she is taking is very low. It is advisable to increase it to 15 mg once a week. Continue Folvite and HCQS.

Steroids on an oral basis, I will not recommend it since it will cause more side effects. For the current situation, she can take intramuscular steroids if needed to combat the emergency situation but not on a long term basis. Make sure she takes calcium and Vitamin D as well (tablet Shelcal 500 mg once daily and Capsule Uprise D 3 60 k once a week).

Final prescription:

1. Tablet Folitrax 15 mg once a week.

2. Tablet Folvite 5 mg once a week.

3. Tablet HCQS 200 mg twice daily.

4. Tablet Shelcal 500 mg once daily.

5. Capsule Uprise D3 60 k once a week for eight weeks.

6. Tablet Nucoxia 90 mg SOS for pain.

Review with a rheumatologist as and when possible.

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