A 60 yr male. Physically mentally fit. Rheumatoid arthritis diagnosed 2 yr back.Pt is on methotrexate 15 mg weekly. Folic acid 5 mg  5 days a week. Leflunomide 20 mg od. Currently no joint pain and swelling. No joint deformity.

ESR 80 Das28 =4.9 approx CBC... LFT, RFT normal. Please advise the next step in management. Now patient has mild itching on feet and palpable rash on feet. No other complaint. What is the diagnosis?