So is the treatment working?

I've now been taking methotrexate+folic acid and hydroxychloroquine for 9 weeks.  The empty spaces in a blisterpack of folic acid mark progress, one for each week.  It's at this time you begin to ask the question, 'Is it doing any good?'.

A couple of months' back I asked my rheumatologist 'How would we measure improvement?'  At the time I knew that I'd posed the question in a rather nerdy way but it was the right question.  The answer came 'We gauge process clinically' (I presume this is about mobility and articulation).  Measurement e.g. by MRI scan would just be academic and even people with few clinical symptoms could show signs of inflammation on the scan.  Fair enough!

My current test is the ease of climbing the stairs at home, the first time in the morning, typically 40-60 minutes after I get up.  Sometimes I reach the bottom of the stairs and go to take the first step with my left leg and freeze with the pain.  Fast joint movement is not possible.  The step has to be taken slowly and even then is uncomfortable.  And yet later in the day, I can take two steps at a time. Ironically, if I get a better night's sleep, movement in the morning is more difficult.  Which to prefer good sleep or a pain free start to the day? Despite this confounding factor the stairs test is a good mark of progress. Even then sufferers of rheumatoid arthritis complain of flare ups: the disease and its treatment do not progress in a smooth fashion so it's harder to assess whether the situation is improving.

Another gauge is whether I find it possible to ride out of the saddle, i.e. 'standing' on the pedals.  In late summer this was not very possible.  More recently, particularly later in the day, it feels natural and comfortable.

Typically sources suggest benefits take 1-3 months to be felt.  In my case, I'm ramping up the dose month by month, 7.5, 10, 12.5, eventually to 15mg/week and taking blood tests every two weeks to check that there are no adverse effects.  So I won't even have stabilized on my final dose over the three month period,  Of course if my condition has improved should I put that down to the hard medication or to honeygar?