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How long do I need to take medicines for rheumatoid arthritis?

Q: I am RF factor positive and my anti-CCP count is 86. I have seen a rheumatologist and I am on HCQS 200 mg morning and evening and methotrexate and folvite every week. But I am not taking calcium. I take evening primrose dietary supplement. I have improved a bit. I was on 5 mg oral prednisolone but doctor told me to stop this. Since I have started on Methotrexate, I am losing hair. Is it a side effect and what can be done? I want to know if my disease condition is very bad and will it improve? I also want to know if I have to continue these medications lifelong since all these medication have side effects? My BP is on the lower side. My Hb is 11.8 and ESR is 13 and my SGOT and SGPT are in normal range and C-reactive protein is negative. Please advise.

A:Methotrexate is the standard medicine for rheumatoid arthritis. The dose is 10 mg per square meter body surface per week. It is one of the safest medicine known to human beings, has now been used for over 20 years in this disease with very little side-effects but it does require regular monitoring of liver functions tests - mainly AST and ALT levels. Regular blood counts are also necessary at least once in 2 - 3 months under the direction of the doctors. Hair loss is temporary and they always regrow to normal levels. Therefore, you should not have any fear in using this medicine under the directions of a competent rheumatologist. Using unscientific unproven remedies like primrose etc. should be strongly condemned; not be used, they have no proven efficacy in rheumatoid arthritis. On the other hand, regular doses of folic acid, as advised by your doctor, must be taken (avoid it on the day you take methotrexate - once every week). Like several other chronic diseases (like diabetes, high blood pressure etc.) medicines have to be taken continuously for the whole life to keep the disease under good control. If this is not done, there will be serious adverse effects of the disease on the body including crippling and twisting of the joints with disability, increasing clogging of the blood vessels that may cause problems in the heart and brain. Hope you continue to take proper scientific medicines under the directions of your rheumatologist.

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