Humira and low dose MTX not working for RA

 

Question  I was diagnosed just about a year ago. I have been on Humira injections since May of 08 and have been taking methatrexate since mid December. I started with 3 pills a week and I am up to 5. Nothing seems to work. I continue to have swelling and pain in my fingers and hands and pain in my feet and knees every day. The only thing that seems to work is 15mg of prednisone daily. Should I stay on the prednisone or talk to my doctor about a different medication.
 
Answer 

Hi Barbara,

You haven't been on MTX long enough nor at high enough dose to determine whether it will work for you or not.  We usually want patients to be on at least 15 mg per week (that's 6 tablets), and many patients require up to 20-25 mg per week.  Plus, it takes 1-2 months at each dose to see if it is working. That's why at HOpkins we start right away with 15 mg per week (unless the patient has hepatitis, drinks a lot of alcohol,, or other reason to not use MTX or use lower doses).  That way we don't lose time at the lower doses which are usually not very effective. At the higher doses MTX is a great drug, especially in combination with Humira or other biologic drug.

Last update: 04:39 PM Saturday, February 28, 2009

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Joan Bathon, MD

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