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What Causes Pain In Shoulders, Hip Joints And Knees Post Methotrexate Withdrawal?

Posted on Mon, 16 Mar 2015

Question: Hello Doctor, I was diagnosed RA+ around 15 years ago, and was taking 17.5 mg. Methotrexate (once a week), and Plaquenil (HCQS) 200 mg. (daily) for around 15 years. The results were very good .. I was in remission for a long time with the normal aches and pains now and then whenever humidity increased or it was cold. Due to relocation, after seeing a doctor, a year ago, I was taken off the Methotrexate and the HCQS was prescribed twice a day. Now I find that my shoulders, hip joints, knees and wrist hurt. Also the nodes in my fingers are painful. Since the Rheumatologist was a visiting doctor, should I revert to my older prescription of Methotrexate and HCQS which stood me in good stead for so long?

Answered by Dr. Naval Mendiratta (28 minutes later)

Brief Answer:
treatment for rheumatoid arthritis

Detailed Answer:
Good evening

Thank you for writing on Health care magic

Well if the diagnosis of rheumatoid arthritis is confirmed it will be hard to go off methotrexate
Moreover now we know, if you stop methotrexate then your arthritis will flare up.

You should restart your methotrexate again as plaquenil is a quite a mild drug for control of arthritis. It won't do much in controlling the disease

I would suggest you restart your methotrexate, just make sure your baseline liver function tests and complete blood counts are normal. For immediate relief you can take a brief course of steroids till the action of methotrexate kicks in. Either injection depomedrol 80mg weekly or low dose oral 20 mg and taper and off within 4 weeks.

If it doesn't get better we will need to add some other medication.

Hope the information was useful.

Do let me know for more queries

Regards.
Dr naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (56 minutes later)

Thanks for your reply Dr. Naval. I did a blood test on 16th Feb and some of the readings were: Haemoglobin 11.7 gms%, white blood cells 4,900/cmm, ESR 38 mm, blood glucose random 76 mg/dl, blood urea 18 mg/dl, s.creatinine 0.9 mg/dl, s.uric acid 3.7 mg/dl, SGOT 31 units/ml, SGPT 19 units/ml, alkaline phosphatase 125 IU/L, s. calcium 7.6 mg/dl, gamma GT 40 U/L. With these figures, can I re-start 17.5 mg methotrexate once a week, and one 200 mg HCQS per day? Thank you in advance.

Answered by Dr. Naval Mendiratta (14 minutes later)

Brief Answer:
treatment of rheumatoid

Detailed Answer:
Good evening

Your blood reports are fine. You can restart the medications. Also supplement with calcium and vitamin d as the calcium is very low

Do let me know for more queries

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (31 hours later)

Thank you Doctor .. I have re-started the methotrexate. You have relieved me of my constant worry of the disease crippling me ever since this was stopped, and there being no Rheumatologist to consult personally. Initially at the start of the disease, I was given the Gold injection a few times when I had a flare up causing intolerable pain. Later I was prescribed Naproxen to be taken twice or thrice a day as an SOS. However I find that whenever I have taken Naproxen, I have ended up being constipated. Which other pain reliever would you recommend or is Naproxen the best that can help in this situation? Best regards.

Answered by Dr. Naval Mendiratta (7 hours later)

Brief Answer:
Treatment For rheumatoid

Detailed Answer:
Good evening

Well, Gold is outdated now due to the wide range of side effects it has. There are much better drugs available but since you have been doing good with Methotrexate, you should continue that.

As for the pain killers, Naproxen is quite a safe drug but if you have the side effects you can try with Tablet Nucoxia( Etoricoxib 90 mg once a day. It is one of the recommended ones. In case not this, you can try a combination of Aclofenac and Paracetemol as well. ( Zerodol P twice a day)

I would recommend a short course of Depomedrol injections 80 mg weekly for 3 weeks to relieve your symptoms and minimize the use of painkillers.

Hope the information was useful

Do let me know for more queries

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Naval Mendiratta (7 hours later)

Thank you Doctor .. appreciate your very helpful and quick responses to my doubts and queries. I will follow the instructions given above. I am in Goa and hope I can contact you again through Health Care Magic after around 3 months, after new blood tests to ascertain the results of Methotrexate etc.
Thanks once again and best regards.
XXXXXX

Answered by Dr. Naval Mendiratta (1 hour later)

Brief Answer:
treatment Of Rheumatoid

Detailed Answer:
Good evening

Oh yes you definitely can. I am glad I could be of some help .Wish you healthy and pain free life ahead

Feel free to contact me for more queries

REgards
Dr Naval

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Pradeep Vitta