A 52-year old male in generally good health began to feel soreness and painful twinges in his fingers. The inflammation was not in the knuckle joints but rather in the tissue surrounding them, which became increasingly red and sensitive to touch. Having previously used Vitamin C (ascorbic acid) and methotrexate in succession to treat a case of idiopathic thrombocytopenic purpura, and having an old prescription for methotrexate, he obtained methotrexate from an online pharmacy and began to take it.