Question
Approximately six months ago I was diagnosed with RA. In March I had my first appointment with a Rheumatologist who has done an excellent job of explaining RA to me and her treatment plan. At that time my wrists were extremely painful, and several nodules were present. I was running a low grade fever and was exhausted all the time. I also had some pain in my shoulders, and pain and stiffness in my hips made walking a chore. I am currently taking two 750mg Relafen tabs a day, 5mg Prednisone a day, five 2.5mg Methotrexate once a week, and one 1 mg Folic Acid a day. Initially I was taking only four Methotrexate tabs but my Rheumatologist tweaked it upwards to the current five tabs. So far I am tolerating the Methotrexate very well. My hips and shoulders have improved considerably, but the wrists remain very painful, particularly when I first get up in the morning, and for several hours thereafter. For a while, the nodules disappeared, but now another nodule has appeared in my right wrist. It is as if my wrists are stuck in neutral. Am I expecting too much too soon for improvement in my wrists, or is it common to have to tweak the Methotrexate from time to time to obtain optimal results?
Answer
Since methotrexate can take about 4 weeks to have an effect, when starting methotrexate, it is common to increase the methotrexate dose every 4 to 6 weeks, checking lab tests to make sure there are no side effects. The maximal dose of methotrexate is usually 25 mg weekly for most patients, but lower doses for older patients or patients with other medical problems.
