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Am I on right medication for pain in shoulders and fingers?

Q: I am 39 years old and suffer from occasional pain in my shoulders and fingers. It was found out that I am RF-factor positive and my anti-CCP result was 86. The doctor prescribed HCQS 200 mg to be taken twice daily, 10 mg of Methotrexate once a week and Folvite once a week. Am I on right medication?

A:I hope you have been seen by a rheumatologist, specialist physicians treating this condition. I strongly recommend that if you are not under the care of a rheumatologist, then you must seek it. If you are already under the care of the rheumatologist, then it is ok. The dose of Methotrexate is rather small. If you do not show response in 3-4 weeks, the dose should be increased to 15 mg weekly for a few weeks and, if still the disease is not fully controlled, then it may be increased to 20 mg dose once every week. Adjunct treatment with folic acid at least 1 mg daily (except on the day of Methotrexate), calcium, bisphosphonates, treatment of high blood cholesterol and triglycerides (if they are abnormal), stringent control of BP (if it is more than 120/80) are the other things that must be carefully looked into. I must mention that methotrexate is better absorbed if it is given as subcutaneous injections, especially if the dose is more than 15 mg weekly.

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