Should I switch my Methotrexate or add Prednisone for my RA?

Question

Hello doctor,

I have been living with rheumatoid arthritis for many years and have been treated by several doctors. My most recent treatment included 15 mg of Methotrexate per week and daily Salazopyrin (Sulfasalazine), but I had to stop Salazopyrin as it affected my kidneys. I am currently experiencing a severe flare.

Should I increase my Methotrexate dose or take Prednisone along with it to manage the symptoms?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

It sounds like you have been managing rheumatoid arthritis for a long time, and going through a flare after so many years can be really frustrating. The pain and stiffness you are feeling now are most likely due to increased inflammation in your joints.

About Methotrexate:

You are already on 15 mg once a week, which is a moderate dose. Sometimes, doctors increase it to 20 to 25 mg during active flares, but this should only be done under your rheumatologist’s guidance. Before adjusting the dose, they will usually check your liver and kidney function to make sure it is safe. Try not to increase it on your own.

About Prednisone:

A short course of low-dose Prednisone (around 5 to 10 mg daily) can help calm things down when symptoms suddenly worsen. It can reduce swelling and pain while Methotrexate continues to work in the background. Still, it is important to taper it slowly and not stay on it for too long, since steroids can affect bones, blood sugar, and immunity.

Some helpful reminders:

Keep taking Folic acid with Methotrexate, as it helps protect your liver and blood cells.
Get regular blood tests for kidney, liver, and blood counts.
If Methotrexate alone is not enough, your doctor might add another medication like a biologic (Adalimumab, Etanercept, or Tocilizumab), which can help control inflammation safely.
Try gentle exercises, stretching, and warm compresses; they can make your joints feel a bit easier to move.

In short:

Do not adjust methotrexate on your own. Reach out to your rheumatologist soon. They might temporarily add Prednisone or adjust your treatment plan to help you get better control of your flare, while keeping your kidneys safe.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.