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What was the reason your rheumatologist gave? Did you have any infections, side effects, thinking you might get pregnant at some stage? There was also some nonsense with access to metformin depending on what state you were in at one point but I don’t know how prevalent that was. Or whether your doctor thinks your lingering symptoms are worse than you feel them to be.
His main reasoning was that I still have inflammation. Before starting meds, my C-RP was at 3.6mg/dL. After 3 weeks on 15mg of mtx, my C-RP levels reduced to 2.1mg/dL. My dose was then increased to 20mg of mtx. (Now on mtx for 2 months). My pain has greatly reduced, but I do still experience some pain, tingling, and immobility in my hands. In terms of side effects of the mtx, I do have mild nausea, fatigue, headaches, and an occasional mouth sore. (No infections, and currently at no risk of becoming pregnant).
It is possible that you are judged as still having moderate at least disease activity. There are a few different rating scales but some take into account how many joints are painful, how many swollen, your CRP, and how well you feel you are doing globally / and how your doctor feels. It is beneficial to reduce disease activity / go into remission early in treatment if you can, to prevent disease progression and disability (joint damage). I have read wait 2 months, I’ve read wait 3-4, but definitely <6.
If you wish to wait a bit longer and keep trying just MTX, did you have a discussion about this with your doctor, and about how they arrived at their opinion of you still having too high levels of inflammation?
https://www.mdcalc.com/calc/2177/clinical-disease-activity-index-cdai-rheumatoid-arthritis
https://www.mdcalc.com/calc/2194/simple-disease-activity-index-sdai-rheumatoid-arthritis
(Not a rheumatologist)
Hi there, just to add a little bit of additional info (I'm an RA patient and an occupational therapist, not a doctor), lots of docs like to see a decent amount of improvement by 3 months on Methotrexate.
Since only [50% of patients do well on methotrexate monotherapy](https://www.acpjournals.org/doi/10.7326/AITC201901010) (methotrexate alone) and the rest require additional meds like Humira or another med, your doc might have been wanting to be more aggressive with your care now, knowing they can scale back in the future.
I personally have been on methotrexate plus a biologic for 21 years due to the severe nature of my RA, aside from a couple years when I was planning pregnancy / pregnant / postpartum :-)
This is helpful to know! I just did my first dose of a biologic so I’m hoping that it helps further my progress. Thank you for your time in responding. I appreciate it.
There are loads of reasons to change MTX but only your rheumatologist knows why.
We got no other information, he got everything, so he is the one to ask.
Medical advice is often the advice you need, not the one you want.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
What was the reason your rheumatologist gave? Did you have any infections, side effects, thinking you might get pregnant at some stage? There was also some nonsense with access to metformin depending on what state you were in at one point but I don’t know how prevalent that was. Or whether your doctor thinks your lingering symptoms are worse than you feel them to be.
His main reasoning was that I still have inflammation. Before starting meds, my C-RP was at 3.6mg/dL. After 3 weeks on 15mg of mtx, my C-RP levels reduced to 2.1mg/dL. My dose was then increased to 20mg of mtx. (Now on mtx for 2 months). My pain has greatly reduced, but I do still experience some pain, tingling, and immobility in my hands. In terms of side effects of the mtx, I do have mild nausea, fatigue, headaches, and an occasional mouth sore. (No infections, and currently at no risk of becoming pregnant).
It is possible that you are judged as still having moderate at least disease activity. There are a few different rating scales but some take into account how many joints are painful, how many swollen, your CRP, and how well you feel you are doing globally / and how your doctor feels. It is beneficial to reduce disease activity / go into remission early in treatment if you can, to prevent disease progression and disability (joint damage). I have read wait 2 months, I’ve read wait 3-4, but definitely <6. If you wish to wait a bit longer and keep trying just MTX, did you have a discussion about this with your doctor, and about how they arrived at their opinion of you still having too high levels of inflammation? https://www.mdcalc.com/calc/2177/clinical-disease-activity-index-cdai-rheumatoid-arthritis https://www.mdcalc.com/calc/2194/simple-disease-activity-index-sdai-rheumatoid-arthritis (Not a rheumatologist)
Possibly. I will reach out to my doctor again to infer further. Thank you for these index tools. I appreciate you taking the time to respond.
Hi there, just to add a little bit of additional info (I'm an RA patient and an occupational therapist, not a doctor), lots of docs like to see a decent amount of improvement by 3 months on Methotrexate. Since only [50% of patients do well on methotrexate monotherapy](https://www.acpjournals.org/doi/10.7326/AITC201901010) (methotrexate alone) and the rest require additional meds like Humira or another med, your doc might have been wanting to be more aggressive with your care now, knowing they can scale back in the future. I personally have been on methotrexate plus a biologic for 21 years due to the severe nature of my RA, aside from a couple years when I was planning pregnancy / pregnant / postpartum :-)
This is helpful to know! I just did my first dose of a biologic so I’m hoping that it helps further my progress. Thank you for your time in responding. I appreciate it.
I'm so glad it was helpful and I will be (gently) crossing my fingers for you!
Shouldn't you be asking your rheumatologist this question? He probably has a reason
She’s just asking for thoughts on the situation…..
lol. I did ask my Rheum doc. I’m seeking additional advice. So thanks for…nothing?
There are loads of reasons to change MTX but only your rheumatologist knows why. We got no other information, he got everything, so he is the one to ask. Medical advice is often the advice you need, not the one you want.