Have little flares of various joint of my hands. They last 24-48 hours and since starting Mtx 15mg and hydroxychloraquine over15 months ago, are very mild and infrequent don't interfere with my driving as they used to. When saw consultant recently she suggested I increase dose of Mtx to 20mg weekly as she could see the swelling and redness. My pain scale was a possible 1.5-2. My ESR and Crp are always normal.
The thought of increasing Mtx took me aback. I've had pain of 8 in hands and shoulders so this little flare was incidental to me and knew the reason why It had occurred (work related stress).
Others on this site have seriously bad flares so mine to me was inconsequential, should I increase Mtx and risk potential side effects when at present none or go with an increase dose and completely annihilate the flares.
She was leaving decision to me.
Any rational for increasing dose or maintaining the status quo would be gratefully received.
I think you might not notice any increase in side effects from 20 mg of Mtx. It's always a case of 'suck it and see'.
Fingers don't seem that important when pain is minimal but loss of function in hands can be devastating. I guess it's easy to forget that the main point of DMARDs is to control the disease and prevent joint damage rather than to address pain as such.
I speak as someone who has only had one flare which lasted a long time, was pretty awful & resulted in a lot of rapid joint damage. Could be that short flares aren't so damaging, I just don't know and probably your rheumy can't be sure either, but in your position I'd probably err on the side of caution.