stop methotrexate
continue folic acid 5 mg daily
HRCT chest every 6 month
for the other case that are suspected Wegners granulomatosis
 Ask about rhinitis, sinusitis, hoarsness of voice, hematria, weight loss

laryngoscopy for exclusion of vocal cord granuloma and tracheal stenosis , Order urine analysis for proteinuria and haematuria, ESR,CRP,  ANCA P and C