Can we start hydroxychloroquine in a 55-year-old patient being treated as RA (negative RA factor and negative anti ccp) already on methotrexate, leflunomide, prednisone 5mg. Has waxy ridges on nail. Patient had synovitis in multiple small and large joints, had bilateral carpal tunnel which has improved, swelling in both hands.
Patient has some improvement in form of decreased swelling in hands but still has pain in multiple joints also suffering from side effects of drugs, Hb has dropped from 12 to 10; had an episode of pancytopenia now improved and massive hair loss. What treatment can be given?
