Medication To Go Alongside Methotrexate?

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by CazH on Mon Oct 05, 2020 4:51 pm

Medication To Go Alongside Methotrexate?


I hope you’re well. Both of my parents have a form of arthritis, and I have my own joint & muscle issues too, so it’s great to see an arthritis clinic!

My father as rheumatoid arthritis. He was initially on steroids and Methotrexate but he weaned off steroids fully last year and now only takes 8 Methotrexate each week, so been on this for a couple of years now. He struggles quite badly with his knees, but it also affects others areas like his hands, so it can be a bit debilitating. He’s not finding the medication to do quite enough, but he doesn’t really want to increase the dose. I think the maximum is probably 10 anyway. Is there anything you might suggest to go alongside this that’s as safe as possible? It’s something I’m talking to his rheumatologist about but I’d like to get another opinion. I use Hydroxychloroquine but I’m not sure that would really do enough for his RA.

Many thanks! :)

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by Arthritis Action on Mon Oct 05, 2020 5:01 pm

Re: Medication To Go Alongside Methotrexate?

Hello Caz. You are right, 10 methotrexate tablets (25mg) weekly is the maximum dose. All rheumatologists follow a "treat to target" approach which means controlling the inflammation caused by rheumatoid arthritis as much as possible, preferably so that patients have no joint pain and tenderness and normal inflammatory markers (blood tests that measure inflammation). Joint pains can also be caused by osteoarthritis, however, and these pains will not be helped by methotrexate, so your father needs to be examined to see if there are still signs of active inflammation in his joints. If there are, his treatment will need to be changed and there are several options.
1. Methotrexate given by injection instead of tablets can be more effective
2. Add another medication to methotrexate, for example hydroxychloroquine (a mild drug) or something stronger such as sulfasalazine or leflunomide
3. Stop methotrexate and switch to one of the alternative medicines above
4. If none of the above work, he may be eligible for a so-called biologic medicine which are reserved for people for the worst arthritis that hasn't responded to usual treatments.

If your father's joint pains are caused by osteoarthritis rather than rheumatoid arthritis, self-management is vital - see our website for more details, but keeping to a healthy weight and exercise are very important. He may also be offered physiotherapy or joint injections, or as a last resort surgery, although obviously he should try all the self-management options first. Good luck!

Dr Wendy Holden
Consultant Rheumatologist and Medical Advisor to Arthritis Action.

020 3781 7120

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