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Pain and swelling on ankles and hands. Taking methyl prednisolone. Safe to take folitrax?

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Practicing since : 1999
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Dear Doctor,
My wife is 53 years old has pain and swelling on ankles and hands. She was given Methyl Prednisolone 8 mg for 7 days and 4 mg for 10 days plus Sulphasalizine & HCQ for one month. Now tests show RA, CRP & HLA B27 negative but Anti CCP antigen 107.4. Doctor has prescribed her Folitrax 7.5 mg per week with HCQ 400 mg daily and Folic Acid 500 mg twice weekly. I shall be grateful if my following query is answered.
"Is it ok and is the prescription of Folitrax necessary keeping in mind the side effects XXXXXXX
Posted Tue, 16 Apr 2013 in Bones, Muscles and Joints
Answered by Dr. Divya Agarwal 1 hour later

Your wife is suffering from rheumatoid arthritis, and you should be aware that folitrax(methotrexate) is the anchor drug for arthritis. Without this medicine, other drugs also don't work much. Methotrexate when it is used, definitely needs some monitoring in the form of checking her blood counts and her liver enzymes once every 4 weeks initially and later once in 12 weeks. If these are normal, there is not much to be bothered about. Also the dosages used in arthritis are very low and usually we don't need to go over 20 mg weekly.

In fact, what you should be concerned about is that her steroid intake should be tapered and kept to the minimum, since it has the maximum side effects.

She has an early disease, which is very well controllable and she can lead an absolutely normal life. However, please keep in touch with a rheumatologist for her arthritis.

I hope I have been helpful.

Above answer was peer-reviewed by
Follow-up: Pain and swelling on ankles and hands. Taking methyl prednisolone. Safe to take folitrax? 1 hour later
Thanks a lot for prompt response.

Treatment is under a Rheumatologist only and the steroid has been completely stopped since 7th March. Her pre-treatment tests were normal except ESR which was 29 in Feb but on 21st March ESR was 10 only.

When RA facor is negative, can it still be called Rhematic Arthritis ?

There is a lot of fear in the mind that Folitrax is a chemo drug having very serious side effects. How much is risk of side effects with small dose of 7.5 mg per week and how long one may need to take it. Hope it is not required life long.

Answered by Dr. Divya Agarwal 5 hours later
Folitrax is also used as a chemotherapy drug, as most of the medicines used in rheumatology have been borrowed from oncology; however, the side effects are negligible due to very small dosages.
Rheumatoid arthritis is a clinical diagnosis in which RF may be positive or negative, so it is not governed by blood tests.
Since she has an early disease the disease may go into remission, however it is very difficult to predict this at this point of time.

Above answer was peer-reviewed by
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