Is starting methotrexate "overkill "

Are you seeing a rheumatologist? I, my daughter and a friend all have autoimmune disorders and have been offered Plaquenil first, sometimes prednisone and yes a stronger NSAID (I read that flurbiprofen has half the anti-inflammatory properties of steroids, which is high). From my experience methotrexate is not first line but maybe your doctor can explain the reasoning.

My mother and another friend, who do not have autoimmune disorders, have swollen hands and along with Plaquenil, occasional steroids, NSAIDS, hand PT therapy has been really helpful. They provide compression gloves, utensils, customized splints and, of course, exercises.

My mother did well with low dose steroids (Like 2mg!). She did that rather than a large dose at one time.

Yes, I saw a rheumatologist, and her recommendation is methotrexate. She said it was okay to take Aleve for awhile to see if I don't get worse. (But I believe she's thinking I'll end up with the methotrexate.) I also have osteoporosis, so steroids are not recommended because they may compromise my bones.

Thank you for your response!

I have osteoporosis and a few days of steroids is okay but not a long term solution.

Aleve is not as potent as some NSAID's that are available.

I would try hand PT!

Yes, I’ve doing that, and it’s helpful. The compression gloves at night are slightly helpful. Thank you.

@theodorastronger Welcome to Mayo Clinic Connect! I’m so glad you found this site and jumped right in with your question. You will find that the members here are very helpful. I’m so sorry about your hands and fingers. And hope you’ll find a solution

@theodorastronger
Some years ago I was treated with MTX for autoimmune collagenous colitis- one injection per week x 4. I really didn’t have major side effects, maybe some nausea. It treated the colitis.
Years before this I took MTX as part of chemo for breast cancer. That’s another story. 3 potent drugs in high concentration- nausea etc.

Thirty four years ago I went through the various med stages for Reactive Arthritis. Last was methotrexate for a few months, and the RA (also called Reiter's Syndrome, and a marker is the HLA-B27 antigen). The arthritis went away hasn't returned (I'm 70). Side effects were minor nausea if I looked down and felt more tired. NSAIDs are not recommended if someone has GI problems, especially colitis due to bleeding and irritation.

I feel some crucial information is missing here. MTX is used commonly for rheum conditions but swollen fingers isn’t a diagnosis. So what exactly do you have and what condition is your dr trying to treat? If it’s arthritis from an autoimmune disorder (mixed connective tissue disease)? then MTX may be appropriate. I appreciate your concern and think a conservative approach like NSAIDS makes sense to try first.
I would clarify with your dr what is causing your finger swelling and what your diagnosis is. If you can’t get a straight answer, get copies of all your lab and imaging reports and see what you find there. Also, consider getting a second opinion to clarify the issue. I have taken MTX for years and do just fine with it. It’s considered a second line drug in the arsenal against autoimmune inflammatory disorders. Let us know how this works out please and good luck.

Thank you for sharing your MTX experience.

I read that the injectable MTX may cause less nausea than the pills. I hope that's true.

Thank you! Based on only the symptoms of my swollen stiff fingers, the Rheumatologist thinks I have either RA or Psoriatic Arthritis. I had an enormous battery of blood tests. I'll try to seek a second opinion.