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What drugs can be used to prevent rheumatoid arthritis ?

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Practicing since : 2001
Answered : 12754 Questions
Dear Doctor,
My father is around 72 year old person. He weighs around 64 Kgs., with a height of 163 Cms. He is a borderline diabetic since around 10 years and mild hypertensive on treatment. He is kept on Insulin Sensitizers as he is not able to tolerate with Sulphonyl Ureas or Bigunides – when used earlier he was going into hypoglycaemia. That is why he was prescribed with Metformin 850mg. IPR.
His hypertension readings periodically recorded as–
09-03-’11-----170/70, 18-04-’11----150/90, 23-05-’11-----150/70, 30-06-’11-----150/70,
Glycosylated Heamoglobin recently tested ----7.4
His Blood Sugar Levels since some time recorded as—
01-02-’11----135 & 177, 18-04-’11----88 & 112, 20-05-’11----64 & 122 Fasting & Postprandial respectively.
Since last two years he is detected with Rheumatoid Arthritis with swelling in the finger nodes. After a three months thorough titration of the medicines, one famous Rheumatologist has stabilized the treatment for Rheumatoid Arthritis. As a whole now he is on the following medication---
For Hypertension & Diabetes-
Telmesartan-80mg---O.D., Amolodipine-5mg---O.D., Metadoze(Metformin)-IPR-850mg---O.D., Rozat-10mg—O.D., A-Z Gold---O.D., Omeprazole-20mg---O.D.,
For Rhematoid Arthritis---Leflunamide-20mg—O.D., HCQS-200mg.—O.D., Methotrexate-10mg---Once A Week, Deflazacort-6mg—O.D., Folvite-5mg---Thrice a week O.D., Calcirol Sachet—Once a Week, Riboflavine-O.D.
Actual Problem Now:-
Now the actual problem is that because of the side effect of Methotrexate, he is getting severe mouth ulcers (Stomatitis) which is unbearable even if he takes an atom of spice or XXXXXXX chilly, or even the flavour of XXXXXXX chilly in the food also causes severe unbearable burning sensation. For this all sorts of Mouth Paints and other Stomatitis medications are used. In the current state of controlled Rhematoid Arthritis, we cannot withdraw Methotrexate and take a risk.
Please suggest a good medication for this Mouth Ulcers which is really causing a XXXXXXX trouble to my father due to which he food intake is getting reduced day by day.
Thanking you.
Posted Mon, 7 May 2012 in Arthritis
Answered by Dr. Rakhi Tayal 21 minutes later

Thanks for writing to us.

Benzocaine and glycerine based local paints are helpful in the treatment of mouth ulcers.

Recurrent and persisting mouth ulcers is one of the common problems reported with the use of methotrexate, as his capacity to heal these ulcers are reduced.

Your Rheumatologist can consider withdrawl of methotrexate if mouth ulcers are significant and he is not able to tolerate the drug. He can add some pain killers instead of methotrexate to control the disease symptoms.

Apart from benzocaine / glycerine paints, rinsing the mouth out with warm salted water or rubbing garlic on the sore area will also help to cure his ulcer. Local steroids and antiinflammatory drugs also help in reducing the ulcers.

I hope my answer and recommendations are adequate and helpful. Waiting for your further follow up queries if any.


Above answer was peer-reviewed by
Follow-up: What drugs can be used to prevent rheumatoid arthritis ? 2 hours later
Dear Doctor,
As you know very well that the withdrawal of Methotrexate should not be done obruptly and that aggravates the R.A. Hence, please suggest me something that is more feasible to have a concomittant usage with Methotrexate.
Answered by Dr. Rakhi Tayal 7 hours later
Thanks for writing again.
There is no such drug which if used with methotrexate will reverse its effects on the oral mucosa. You need to discuss a gradual withdrawal of methotrexate with his rheumatologist and replace it with a better disease modifying agents available. A pain killer may also be added. Methotrexate is not the the drug of choice or the only best drug for rheumatoid arthritis. You need to ask for other alternatives suitable for your father from his doctor.
Hope my answer is helpful.
Wishing you a trouble free speedy recovery.

Above answer was peer-reviewed by
Follow-up: What drugs can be used to prevent rheumatoid arthritis ? 1 hour later
Dear Doctor,

Thanks for your response. Few more facts in front of you will be ---
Our Rheumatologist even has discussed with us about the better alternatives to Methotrexate like Monoclonal Antibodies (MABs) which are proved to be better than the above. But, he was reluctant to administer the same considering the age factor and keeping in view that at this age MABs may not be able to provide much improvement in the condition. Hence, after a thorough and XXXXXXX analysis of his medical history of Diabetes & Hypertension, then only he has stabilized the treatment on Methotrexate - that too 10mg O.D. only.
I think reducing the same further to 5mg is of a futile effort in controlling R.A. We have even looked at the option of going to Intra-nodal Injections, which will be only a temporary and contingency management medications.
Hence, can you please guide us with a still more feasible solution if the Medical Science can provide.

Thanking you.
Muralidhar Panchagni.
Answered by Dr. Rakhi Tayal 4 hours later

Thanks for writing again.

It seems that you have already had a thorough discussion with his Rheumatologist.

There are many drugs used effectively to prevent the progression of rheumatoid arthritis. These include TNF alpha blocking agents, Interleukin blocking agents, Monoclonal antibodies etc.

And these drugs can be taken in combination with methotrexate. So please discuss with your doctor regarding these options.

And for the oral mucosal ulcer, local treatment with benzocaine gel will help. Some other ulcer protective agents like sucralfate gel can be taken before every meal to coat the ulcer surface to avoid irritation.

Hope this helps your father.

Above answer was peer-reviewed by
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