An informed patient is always an intelligent patient. Every patient should know about his disease/problem and how to best cope with it. This definitely makes the difference between good management and excellent management.

At the other extreme is the problem of medical information overload. People find themselves increasingly confused with the media barrage of contradictory health advice.

This blog is planned to bring to you the summary of various scientific studies in simple language to solve your daytoday problems related to RA/ Lupus/ other autoimmune diseases. The same otherwise takes years to percolate through the medical fraternity to the patient.

Dr. S. M. Akerkar, 
Consultant Rheumatologist

54 Responses to About

  1. Sampath Kumar says:

    I am 66 years old male. I have been leading a very healthy life style and do not have B.P., Diabetes, Cholestrol or any similar lifestyle problems. Suddenly at the age of 63, I was diagonised as having RA. I was scared. I had at least two to three very painful attackes where my fingers were swollen and immobilised. It was a very painful period.

    Then on the doctors advice I started taking the following medicines.


    Folitrax 2.5



    as per the doctors advice. The first year was difficult. The second year was tolerable. the third, present, year I am seeing a marked improvement as the RA is in remission. I would continue to take the medicines as directed. I know RA is not completely curable. But stopping at the current ( in my case, the initial stage ) level is important.

    I would be willing to answer any questions to the fellow sufferers on my experiences. I am sure with the proper and diligent following of the doctors directives, this dreaded RA is containable and manageable.

    PLEASE DO NOT GET SCARED OF YOUR RA. Fight intelligently and you would succeed.

    Sampath Kumar.


    • AKIL VAHORA says:

      hello sir
      i am 23 old guy and i also suffering from same disease as u have R.A



  2. ANIL JOSHI says:

    I am 40 years old. I am suffering from R.A. since 1999, that time I was just 29. Initially I used to take ayurveda’s treatment. Since 1999 to till I started treatment of Dr Akerkar there was no remarkable release to my diease. But one of my relative told me about treatment of Dr. Akerkar. Since November 2009 I am under treatment of Dr.Akerkar. After the very first month I felt very painless & energyfull. I could start my routine very smoothly. Now a days after the treatment of 1 & 1/2 year I have forgotten about the arthritis. Initial doses of my medicines are now a days are curtailed equal to nothing. Tablet H.C.Q.S., FOLITRAX, & FOLVITE gave me rebirth. So there is nothing to worries about the rheumatism. Better treatment,followup,awareness & strong willpower con conquer over the disease.



  3. ANIL JOSHI says:


    I am 40 years old. I am suffering from R.A. since 1999, that time I was just 29. Initially I used to take ayurveda’s treatment. Since 1999 to till I started treatment of Dr Akerkar there was no remarkable release to my diease. But one of my relative told me about treatment of Dr. Akerkar. Since November 2009 I am under treatment of Dr.Akerkar. After the very first month I felt very painless & energyfull. I could start my routine very smoothly. Now a days after the treatment of 1 & 1/2 year I have forgotten about the arthritis. Initial doses of my medicines are now a days are curtailed equal to nothing. Tablet H.C.Q.S., FOLITRAX, & FOLVITE gave me rebirth. So there is nothing to worries about the rheumatism. Better treatment,followup,awareness & strong willpower con conquer over the disease.



  4. Chandni Sahgal says:

    My Mother 72, is suffering from Psoriatice arthiritis since last 4 years. For past two years her hip, pelvic region and shoulder also got affected.
    Now since 18th June she is suffering from low grade fever 99-101 F acccompanied with swelling and pain in her head along the temples, and jaw stiffness. She has been put on 16 mg medrol and HCQS. And is continuiting Folitexate 15mg weekly and Folvite and calcium. She also has glaucoma.
    Her fever is very worrisome and has made her weak and debilitated.
    DO you think it could be Temporal Artirits? if so what do you suggest?
    Chandni Sahgal


    • Psoritic arthritis, by itself does not cause such fever. One will have to investigate & find out the exact cause of fever.

      If temporal arteritis suspected, the best solution would be to go for a doppler of the temporal artery & a biopsy for a definite diagnosis. This is generally done before or immediately after starting medrol.

      Please speak to your Rheumatologist reg your concerns & diagnosis.


  5. dr joglekar says:



    • Joint pain need not always be related to hysterectomy.
      MRI would definitely help reveal the cause of joint pain. It can reveal inflammation & confirm the diagnosis of inflammatory arthritis versus osteoarthritis.


  6. Shefali Dubey says:

    Hello Dr. Akerkar,
    My name is Shefali and this is regarding my father Dr.S.K.Pandey (58years)who lives in Raipur,Chhattisgarh. He has been having pain in his one knee since last few months and was having difficulty moving as well as burning sensation in the feet. No swelling/inflammation. He was asked to do a blood test and they said that uric acid content has increased which might be causing the problem.They asked my father to avoid protein rich foods and gave him a medication too. He again did a test and went for a 2nd opinion but then in the 2nd test the uric acid content had decreased.
    Few days ago,another doctor asked him to do RF,antiCCP antibody test etc and found that his antiCCP antibody test was highly positive but RF was normal. This is confusing us a bit as to if he has RA or its just an indication that he might get RA. I am very worried as to what should be done to get the treatment started asap. Please advise what steps should be taken.


    • Dear Shefali,

      A positive anti CCP antibody is quite specific for RA. It indicates that your father is either having RA or may develop RA in the near future.

      Rf test is not very reliable & asking for both (RF & anti CCP) is quite funny (when one asks for anti CCP, there is no need of RF at the same time– similar to buying a first class & second class ticket for the same person on the same train!)

      We clinically diagnose RA by the inflamed joints. One will have to carefully see if your father has subtle/ early inflammation in the knees.

      You should consult a Rheumatologist asap for a definite diagnosis.


      • Shefali Dubey says:

        Thank you for taking time to reply Dr.Akerkar. Really appreciate that.My father has stopped taking any pain medications now. There is not an inflammation that the doctor noticed.. But we would definitely try to consult a Rheumatologist soon(since my father suffered a fracture in his other leg! :(.Meanwhile do you suggest any precautions etc that need to be taken


      • Dear shefali,

        Since the anti CCP is positive, please keep a watch on any swelling in any of the joints.
        Ask your father to avoid squatting/ sitting on the floor. This can worsen the knee pain. I’m sure he would not be sitting on the floor right now due to the fracture, but even after the fracture heals, he should avoid this.


      • Shefali says:

        Thanks a lot for your replies Dr.Akerkar..really appreciate it! 🙂


  7. afia fathima says:

    My Father, 52 has been suffering from RA and under treatment since september 2011. He has BP, Diabetes. He had some cardiac problem but it was cured. He found out that he has RA only during sep 2011. and that he started treatment for RA, he was like cured within 3 months. As per the doctors advice he took the following medicines.
    SAZO 500

    But after 3 months he suffered from kidney disfunction. (One of his kidney was already shrinked and the other is working only 20% ) His blood urea and creatinine got increased. Our doctor found that its all because of Wysolone. so he just avoids it. Now he is intaking
    1.Renolog (for kidney)
    2. Sazo 500(RA)
    3.Concor AM 5 (BP)

    Also he was advised not to intake any of those painkillers as it’ll affect kidney. Even though he has been taking sazo 500 thrice daily he’s always in flare . he often gets pain on his knee and elbow and synovial joints ,fingers become swollen. he gets remission period very rarely. he has been suffering always. once he gets pain on his left knee joint it has a routine of transforming the pain to right joint, then to right fingers, then left fingers and the pain will be disappeared then for about 3 to 5 days. There is very less time that he feels good. I really dont feel that sazo is worth intaking. Please suggest me something so that he can live peacefully without these pains. I need my active happy dad again. pls help me doctor.


    • Dear Afia,

      When one has kidney dysfunction with Rheumatoid arthritis, sazo (sulphasalzine) & hydroxychloroquine are the only options as far as DMARDs are concerned. If the renal dysfunction is only minimal, methotrexate/ leflunomide can be considered in small doses in consultation with a nephrologist. The dose of Tab. sazo one can take is upto 50 mg/kg. The dose your father is taking seems to be lower than this optimal dose.

      Please speak to your Rheumatologist (you should see one if you are not), about these other options.
      He cannot be given any pain killers.
      However, wysolone, by itself does not affect the kidneys. Hence, in the absence of other options, one can judiciously consider a small dose of the same.

      Please conslut a Rheumatologist for these changes in the medications. I hope your father is active & healthy again.


      • afia fathima says:

        Thank you very much for your kind reply doctor.
        My dad is undergoing treatment at Apollo in Chennai. He’s under the treatment of both a Rheumatologist (Dr.Shreelekha) and a Nephrologist (Dr.K.C.Prakash). And i thank you for your suggestions. I assure I’ll consult our Rheumatologist about these medications. Thank you again sir.
        You are doing a very good job through your Arthiritis support board. I do agree that an Informed arthiritis patient is an intelligent arthiritis patient.


  8. Marica says:

    I tend not to leave many responses, but i did some searching and wound up here About Arthritis support board. And I actually do have some questions for you if it’s allright.
    Thanks for the informative articles.


  9. Na says:

    I drop a leave a response when I like a post on a site or I have something to contribute to the conversation. It is caused by the sincereness communicated in the post I browsed. And after this post About Arthritis support board; I was actually excited enough to drop a comment 😉 I do have 2 questions for you if you usually do not mind. Could you make a list the complete urls of your communal sites like your Facebook page, twitter feed, or linkedin profile?


  10. Ajith Das says:

    Hi Dr Akerkar,

    My name is Ajith and I am 25 years old. I had developed right knee pain in Aug 2012. After persistent pain for 2 weeks i consulted doctor. The blood test results showed positive RF (1:8 Titer) and he said it indicates monoarticular rheumatoid arthritis. I Had Ayurvedic medication for 2 months and there was no change. Infact last week i was having acute pain on right knee and is starting to develop pain in right shoulder . So I visited doc once again and this time my RF had gone upto 1:60 (dilution) and CRP and ESR was also above nominal range. And doctor have asked me to stop outdoor sports and running. I work in oilfield and work as well is physically very demanding. Doctor has prescribed me Defcort 6mg, Folitrax 7.5, Fol-5, HCQS-200, Strovo-20mg. what would you advice (about medicines as well as physical activity as i am involved a lot in sports) ?

    Ajith Das


  11. pooja says:

    Hello Doctor,
    My mom is 55yrs old and is suffering from swelling in her right knee joint for a couple of months.Though her RA factor shows negative,her doctor has advised her to take Omnacortil,hcqs,folitrax,folvite ,along with some calcium supplements because she had a history of SLE 10yrs back. she is worried about taking omnacortil cause its a steroid.also if you can tell me what are each of these medicines for and if they have any side effects.My mom is diabetic as well.


    • Dear Pooja,

      Please see a Rheumatologist & get a few issues sorted out–
      1) The present & the past problem- it is Rheumatoid arthritis or Lupus.
      2) If it is lupus, low dose steroids (omnacortil) is required i the long run.
      3) There is no need to worry about steroids. They are required in Lupus. You can know more about the side effects here & discuss the same with your Doctor.


  12. Jacqui says:

    You made some great points there. I did a search on the issue and found the best info on your blog.


  13. persis says:

    hi,dr Akerkar,i am 50 years old,and been told that i have psoriatic arthritis,by my rheumatologist i am given folitrax 2.5 on sunday 1-2 f or 4 weeks and then sat/sun 1-2 for 6 mths along with folvite ,i have joint pain and swollen tips on my finger joints.i want to know is folitrax safe for long time consumption.thks


  14. Sumitesh Das says:

    Dear Dr. Kerkar – my father has been suffering from RA since 1993. He has been taking Sazo 500 for many years. In 2008, he developed Rhematoid vasculitis in his left leg leading to gangrene. He was fine till August 2012 when he started developing swelling and feeling numbness in his fingers. Of late, he has developed ulcers in the sole of the foot and near the toes and finer nails. There is also black blood clots. He is presently taking the following medications – Sazo 500 (once a day), Folitrax 2.5 mg (3 tablets once a week). However the ulcers are not going away and we fear it will develop into something more serious. Please advise. Thank you.


    • Dear Mr. Das,

      The ulcers are most likely a result of the vasculitis process. The numbness may also be a part of the same (due to involvement of the nerves)

      Pl see your Rheumatologist. He would improve with a high dose of steroids & immunosupressants like cyclophoshamide or azathioprine.


  15. Sagar says:

    Hello Doctor,

    My uncle is 50 years old who has been diagnosed of RA since last 5 years and he is on Folitrax – Twice a week.

    Since last three months , he is facing Vomitting post taking this medicine since last 3 months.
    He got his liver function checked, reports says its ok as of now.

    But he is little skepticle about taking this medicine as he gets vomitting a lot.

    Should we seek a change in medicine.

    Requesting your valued suggestion.

    Thanks & Regards


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  17. Hitesh rajpal says:

    Hello doctor,

    I am 25 years old,I got my anticcp test done recently which showed Hla B27.I have got swelling in my right calf and right wrist. I concerned a rheumatologist, right now I am taking tab Saaz,folitrax,etoshine 90,autrin,idrofos,sompraz and pentasure hp powder in milk.Are these medicines okay to be taken at the same time do they have any effect on the kidney?Can I take homoepathic medcines along with these medicines?


    • Dear Hitesh,

      Is your anti CCP positive? I could not really make out from your post. Saaz, Folitrax are anti arthritis medications & your Rheumatologist would guide regarding these medications.

      Etoshine is an anti inflammatory medication & is generally not continued in the long run.


    • Dear Hitesh,

      As a Rheumatologist, the aim would be to control the arthritis with Saaz & Folitrax with T. Nucoxia only on a ‘as & when required’ basis.

      This is a common combination of meds & safe under supervision.

      Please do not combine Homeopathy/ ayurvedic meds with the present treatment,


  18. Nyla says:

    Dear Dr. I am suffering from Arthritis for 20 years & have now consulted a rheumatologist. He has prescribed folitrax on tuesdays & fol 5 on wednesdays & morning Hydroquin. how safe is it to take these tablets continuously? how long should we take these medicines. I do not have pain now. But only one finger is swollen. please advise


  19. Vijay Bhatnagar says:

    Hello Doctor,
    Two month back my mother 85 yrs was diagnosed as suffering from “Late onset of RA and ILD”. The Rheumatologist at Medanta Gurgaon has prescribed HCQS 200 mg (OD), Folitrax 10mg (Once a week), Folvite (OD except the day on which Folitrax is taken), Deryphiline 150 mg (OD), Shelcal HD (OD). To start with she was given Depomedrol 80 mg injections once a week for 4 weeks alongwith the above mentioned medicines. There was remarkable improvement presumably due to the injections. However, now (one month after the last injection) her condition has started to worsen with swollen joints and pain all over the body. The medicines do not seem to be having much effect. I request you to kindly reply on the following points:

    1. Are the given medicines not effective in her case due to the advanced age?

    2. As depomedrol injections have proven very effective, what could be the optimum frequency to give physical relief to her; afterall at her age physical comfort is more important than the fear of side effects?

    3. Is her condition likely to keep on deteriorating with time or could it stabilise at some level with continued use of medicines?

    4. Doctor prescribed calpol 650mg for pain on SOS basis. At present due to extreme pain she istaking it thrice daily. Is it safe dosage at her age.

    I shall be highly obliged for an early response.

    Thaking you,

    Vijay Bhatnagar


    • Dear Mr. Bhatnagar,

      Depomedrol is a steroid & is generally not given in the long run.

      It is generally stopped once the main medicines (DMARDs i.e. Folitrax & HCQs) have their full effect.

      Please consult your Rheumatologist. I’m sure he would increase the dose of methotrexate. Your mother’s age & the ILD may have been the limiting factors for him as far as the methotrexate dose is concerned.

      Please speak to him about your concerns & adjusting the doses of methotrexate/ other DMARDs should provide relief to your mother.


  20. pratibharani says:

    Hello Doctor
    My mother – in-law is suffering FROM RA past 10 years. she went through various treatments like homeopathy, aryuvedic and so on..
    from last 5 year she is using Alopathy…
    Her Medicines are
    H.C.Q.S 200MG
    LEFRA 20MG

    FROM PAST 2 MONTHS ferquently she is falling sick because of low fever 100-101, Increased joint pains and swelling, little bit nausea, and loss of appetite.

    After a series of tests like bone screening, and blood test doctor said it is astro-porasis.

    i am not convienced with doctors argument.

    can you help me


    • Dear Pratibharani,

      Fever with RA can either be due to some infection or due to RA activity. It is mandatory to rule out infection since your mother is on DMARDs (folitrax & lefra).

      RA activity can also cause low grade fever. A Rheumatologist would be able to investigate & guide you regarding the exact cause.

      Osteoporosis would not be able to explain the fever.


  21. Rumki says:

    Hello Doctor
    I am now 26 my weight is 55,female ,unmaried from 2004 i am suffering for psoriasis last year 2011 i visited apollo chennai and they suggested me oinments like propysalic NF6 on effected area, r8 the pacthes are very low in No.. but from last three months i am suffering from joint pain specially right heel , hip portion badly have done almont altect my Vit D(OH) is normal, RA factor negative,Asotitre normal,HLAb27 positive,crp-14 ,hb-11 MRI of SI joint is normal HEEl X ray and SIjoints x ray are also normal,the ortho consultant has prescribed Folvite (5mg) tues-sat in a week and also Folitrax 10mg on sunday. from net i went to know there is chance of cancer /liver cirrhosis ,the doc has suggested me to take injections which is very costly and cannot be afforded by us, my question is is this curable by oral medicines , is there any life risk,can this cause problem in pregnancy in future?


    • Dear Rumki,

      From your history you do seem to have Psoriatic arthritis.

      You should be consulting a Rheumatologist asap for the treatment of the same. Oral methotrexate (Folitrax) is an effective & safe medication for Psoriatic arthritis. You can read more about methotrxate & about its safety

      The costly injections suggested to you must be the biologics (enbrel/ etacept/ Remicade). Every patient does not require biologics. It would be prudent to consult a Rheumatologist for adjustment of the dose of methotrexate for maximum efficacy.

      One cannot plan pregnancy while on methotrexate. The same has to be stopped 3 months prior to planning conception. However, get your arthritis under control as of now & then think about future pregnancy. Pl speak to your Rheumatologist about the pregnancy planning. he can guide you regarding the same. You can also have a look at the pregnancy & medicines guide here.


  22. abhishek singh says:

    My father is 47 yrs old he is suffering from since 5 yrs.he had met with an accident after he had some minor external wounds but accident was huge blow. After 7 months he came to know that he has RA. He started ayurvedic treatment after 4yrs of treatment he visited fortis vashi where dr g h tilve consulted him
    Was prescribed him.he followed for 2 months later he dropped the treatment as he was no more visiting the city hospital.losing hope no much results have come because of any medicines.ayurvedic treatment proved to be a waste of time.
    What should we do we are now? Its been 5 yrs we have tried everything but none had stand on our faith.plz reply


  23. roumita das says:

    Hello Doctor
    I am now 27 my weight is 61,female ,unmaried from 2004 i am suffering for RA last year 2013 i have been visited to doctor last April 25th. He prescribed me

    Folitrax 15 mg once in a week
    Sazo 1000 mg
    Calcium tablets

    Previously there was a huge pain in my legs but after taking medicines my legs are ok but not good . I have a problem in left hand wrist, it is so stiff that iam unable to do anything with hand. Area is too painful. Doc prescribed me calcium but when iam taking it i have a constipation.i have been using folitrax injection for the last 6 months. What should i do for painful wrist area??And i aslo heard that sazo is harmful for liver???? Kindly suggest.

    Roumita from Kolkata


    • Dear Roumita,

      The peristent wrist pain may be related to wrist joint inflammation. Speak to your Rheumatologist about the same. The adjustment of Folitrax/ sazo doses may help. Sazo is not all that harmful for the liver.


  24. vanita says:

    Hello Doctor,
    My wife is 35 yrs old and 2 yrs back she was diagnosed with RA and now is she is taking the following medicines.
    Folvite 5mg
    folitrax 15 mg once in a week
    hcqs 300 mg once in a day
    vitoxy forte (late night)
    lefra 20 mg once in a day

    But as i was reading about the side effects i got to know that folitrax can lead to renal failure, So i want to know what could be the possibilities of renal failure and can she takes the folvite as well on the day when she takes the folitrex .


  25. satish sharma says:

    Hi Doctor,

    I am diagnosed with AS when my HLA-B27 test was positive. I am taking folitrax 25 mg per week since last 1 year but now i want to discontinue it. Kindly let me know if i can stop the dosage immediately or i need to decrease the dosage gradually.


  26. Kreng Jai says:

    There is no update after this, please doc can one get an appointment with you as am diagnosed with AS recently as the gene tested positive and have immobile stiff neck want a second opinion before starting any medication. Have a great weekend.😊


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