Question
My sister is 37 years old and she was diagnosed with RA 2 years ago. She was on 20Mg IV Methotrexate, still with mild symptoms. Her new doctor decreased the dosage to 7.5 Mg PO. She has become more symptomatic and is now taking 10 Mg SC. The new doctor does not like to use high doses of Methotrexate and is going to start her in a combination therapy with Arava. She is young and wants to be pain and symptom free. She does not have erosions on the X-Rays, but she does have swollen joints including the hands, knees, and ankles. What therapy would you reccomend?
Answer
Unfortunately, I can’t comment on your sister’s case as I have not seen her. You need to discuss this with her doctor. There likely is a reason why your sister’s new doctor reduced her methotrexate, perhaps a side effect that you are not aware of. The methotrexate dose of 20 mg weekly is a standard dose used for RA. In a published study, the combination of Arava and methotrexate was found to be effective in patients who were not doing well on methorexate alone.
