Question
Hi, I’m 22 years old, suffering from RA since early childhood. I have relativly long remission periods. I have flares about each 1-1.5 years, and the flares accure mostly on my knees. Currently taking MTX 12.5 mg weekly, 200mg Plaquenil and 250 mg Naxin daily. 2 months ago I had a flare began on my left knee, and only two days ago my rheumatologist did a 80mg Depo-Medrol injection into the knee (after 50 cc liquid suction from the knee). Usually after those injections I feel immidiate relief of pain and the flare is gone, but now my knee is steel swolen and has limited movment. Is this a bad sign? Are there any cases known when injections of corticosteroids can no longer help to patient? Or can it be a wrong injection technique of the doctor? What should I do? Thank ou for your help.
Answer
Generally, if there is a lot of swelling in the joints despite treatment, it means one of two things. Either the doses of the drugs are not high enough or the drugs themselves are not effective. The usual MTX dose is 15-20 mg per week. A dose of 12.5 mg/wk is really small. The usual plaquenil dose is 400 mg per day. both of these could be increased and this may control the knee swelling much better, such that frequent knee injections wouldn’t be necessary. If these drugs at the higher doses are not effective, then thoughts should turn towards other RA medications such as the TNF inhibitors (e.g., etanercept or Enbrel; adalimumab or Humira; infliximab or Remicade).
