How can one manage the persistent knee swelling due to RA?

Question

Hello doctor,

I was diagnosed with RA two years ago, and I am taking treatment for the same. My left knee is affected badly, and the swelling is not coming down. Initially, I was not able to walk, but now I can walk slowly, but cannot climb the staircase or fully extend my left leg. Recently, I have been getting pain in my left wrist as well. I have attached the files.

Answer 1

Hello,

Welcome to icliniq.com.

I went through your post and have seen the reports (attachment removed to protect patient identity). Your rheumatoid arthritis is not controlled, which is evident from your high ESR (erythrocyte sedimentation rate) of 60. The reason for this is that you are not adequately treated. Rheumatoid arthritis is treated by starting two DMARDs (disease-modifying antirheumatic drugs) as follows. Methotrexate is started as a 10 mg weekly dose and increased to a maximum of 25 mg weekly. For you, I would advise 15 mg weekly. You can pick a day of the week, for example, Sunday, and take it every week on the same day. On Monday, you could take Folic acid 10 mg. Start Hydroxychloroquine Sulfate (HCQS) 300 mg once daily. You can take a low dose of Prednisolone 5 mg once a day in addition to Calcium and PPI (proton-pump inhibitor). For the knee problem, you can take an intra-articular Triamcinolone 60 mg into the knee joint. That will control your symptoms till your disease is controlled. Consult your specialist doctor, discuss with him or her, and start taking the medicines with their consent.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Sazo (Sulfasalazine) is a second-line drug and its dose is 1000 to 1500 mg twice daily and not 500 mg. Hydroxychloroquine 300 once a day would be a better alternative. Methotrexate 15 mg is to be taken only once a week. If needed, it can be increased up to a maximum dose of 25 mg.

Thank you.