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If you arent responding to methotrexate after a two-month period, your rheumatologist may try some kind of combination therapy, such as adding sulfasalazine and hydroxychloroquine (called triple therapy) or adding a biologic drug such as etanercept (Enbrel), adalimumab (Humira), or infliximab (Remicade)

Some creams, lotions, and serums with ingredients such as azelaic acid, glycolic acid, kojic acid, salicylic acid, and vitamin C may help lighten hyperpigmentation spots or reduce the amount of melanin your body produces