Methotrexate dose and rheumatology review

[girli1111]

Morning! I have a rheumatology appointment this morning, it’s been 9 months since the last one. Inflammation wise (according to the blood tests) methotrexate plus hydroxychloroquine seem to be doing the trick. Fatigue wise, is altogether another issue! So, my question is, is 20mg of methotrexate (SC) standard? Or should I try and reduce it? Also, I know I have osteoarthritis in some joints, my left hand in particular is quite a problem at times (I’m working and only 49, so I’m conscious of it being quite a problem in the future). Do I address this with rheumatology or is it another specialism I need to see? Should I push for imaging work to be done? .... I’m conscious increasingly of back and hip pain too.... I’m just conscious that opportunities to see the rheumatologist are few and far between and I want to make the best use of the time I have with them. Thanks

[Shalf]

Hello there, You are quite right to prepare and make good use of your Rheumy appointment as they are indeed few and far between.

I was put on 20mg MTX initially plus Hydroxy for around 5 months. Another Dmard was added thereafter. It will depend on how controlled your RA is. I would definitely inform Rheumy of your back/hip pain and your fatigue. Hopefully he/she will examine you. Also mention your hand. The Rheumy may suggest a scan, I have had likewise even with fairly good blood results. Hope it goes well today. X

[helixhelix]

Probably too late now for your appointmemt! But just in case, rheumatology covers all muscloskeletal diseases so includes osteoarthritis. So tell them about everything.

20mg is pretty standard, so will depends on how long you have been stable for as to whether wise to taper down a dose. My experiemce has not been good of tapering - but that doesn't mean yours will be the same.

In thinking about asking for imaging to be done, the question I always ask myself is what difference will it make? I know I have osteoarthritis in knees, hips, back and shoulders. I know it's not at a level that anyone (including me) would consider things like resurfacing or replacement since I can do things even tho' painful. So what difference would having a scan make? I doubt it would make any difference at all apart from having a baseline to measure future deterioration against as there's no treatment. So I prefer to avoid extra radiation and wait until completely necessary. Again, my story not yours, so you could be in a different place.

[girli1111 in reply to helixhelix]

Thank you, I saw your reply after I’d been for appointment, which turned out to be with a nurse I’d not met before. Going to continue as I am for now.