Good but Out of textbook , u did nt mention steroids either for definite or indefinite period of time....while i have put patients on very low dose of steroids i.e 5mg daily as continuation after tappering in flares and now they are doing well without medication....with normal ESR and CRP....sometime symptoms start but responds to analgesics or low dose steroids keeping in check B.P and blood suger level.....although in 5mg dose these adv effects are rare...Those are some patients who did not respond to DMARDs....even in parallel theraphy and denied TNF.α inh
Sir I have seen no effect of allopathic medicine in arthritis But I have seen Homoeopathy medicine are very effective In the treatment of arthritis But it is unfortunate none of allopathic doctors advice to it for homoeopathy treatment
Reduced vitamin D intake has been linked to increased susceptibility to the development of rheumatoid arthritis (RA) and vitamin D deficiency has been found to be associated with disease activity in patients with RA.
Sir you told that there is no involvement of DIP joints still you have shown DIP joints deformation in XRAYS and hyper flexion and extension of dip in SWAN and BOUTONNIERE deformity
Methotrexate intereferes with folic acid metabolism hence it cause megaloblastic anemia due to folic acid defiency. Therefore folic acid is given with methotrexate.