<s>[INST] Dear doctor. My mother feel very painfull at the shoulder joints and pelvic joint, sometimes it was also come with mild fever, the lab findings show asto titer positif, her doctor prescribed mtx 3tab once a week,  dos the asto titers colerate, and what about mtx treament. Tq very much [/INST] Methotrexate will cause anemia and should be supplemented with folic acid As aslo titre is positive, I suggest you get other investigations like CRP,ESR,Ra factor also </s>