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Doctors say most patients do well on methotrexate alone, a drug thats been used for RA since the 1980s, and want to avoid the added expense and toxicity of unnecessary medications

This response was not noticed by the patient except that his itching was reduced

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On examination hyper pigmentation was noted on both palmar and dorsal aspect of hands involving knuckles, creases, feet, tongue, oral mucosa and gluteal region