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Diagnosed with RA, prescribed methotrexate and prednisone. Another advised HCQS. Which therapy to start?

Jul 2013
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Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
I have been diagnosed with rheumatoid artheritis wit RF value 270 and anti CCP antibodies>500. One doctor has prescribed 15 mg of methotrexate with 8 mg of prednisolone. another doctor has prescribed 400 mg HCQS. Which therapy should I start. Methotrexate has probably much more severe side effects because of which I have hesitation in starting the therapy. I am also highly allergic to asprin and ibuprofen
Posted Sun, 22 Sep 2013 in Arthritis
Answered by Dr. K. Naga Ravi Prasad 27 minutes later
Brief Answer:
Methotrexate is Preferable to HCQS.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

As per your description of Lab reports, you have high levels of disease activity and you need a swift response.

As both the medications tend to produce systemic adverse reactions if taken over a prolonged period of time, neither of them are absolutely safe.

Methotrexate is said to be the fastest acting DMARD (disease modifying antirheumatic drug) and its therapeutic effect can be seen within a month. Folic acid supplementation is a must along with methotrexate to counter its common side effects. Whereas HCQS needs to be taken for atleast 8 weeks before any clinical response can be appreciated.

So, I personally prefer Methotrexate to all my patients.

Hope I have justified your query. I welcome any clarification.

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