Advice on Methotrexate

Methotrexate does help a few and I believe that those PMR patients it helps perhaps have another inflammatory arthritis lurking under the PMR symptoms.

I did take it for 2 years, but it did nothing for me. In the end I was beginning to get bad side-effects so it was stopped.

The downside to most of these steroid-sparing drugs is that they can take 11/12 weeks to begin working and that's a long time if you are in pain. 

It comes down to individual choice in the end.  Unless you try it you will never know if it works or not!

 

Hi Gayle, my labs never showed their supposed readings but always showed inflammation. I have been on pred for 2 yrs, and about 6 mos. ago, rheumy added MTX  to wean me down on pred. It really helped me, and I did a rather rapid decrease. I am at 5 mg, no flares, now dropping MTX, a month at a time.  I had no side effects from it. Dr said most likely I will have to remain on 5 mg of pred. Hope this helps your decision  JUDY in MI, USA

It doesn't work for PMR on its own - it may help to allow you to get the same effect with a lower dose of pred in the short term at least. There is an Italian study where they found it did help patients get to lower doses - but it did not make any difference to the incidence of pred side effects:

"Long-term follow-up of polymyalgia rheumatica patients treated with methotrexate and steroids M.A. Cimmino1 , C, Salvarani2 , P, Macchioni2 , R. Gerli3 , E. Bartoloni Bocci3 , C. Montecucco4 , R. Caporali4 for the Systemic Vasculitis Study Group of the Italian Society for Rheumatology"

and their conclusion was:

"MTX-treated patients showed slightly less residual inflammation than controls, with the same incidence of steroid-related side effects. PMR is not a benign condition, as often reported, since one third of patients need steroid treatment for more than 6 years"

I have a friend with PMR who is on MTX as well as pred and she is convinced it does make a difference to her. She has no side effects and still enjoys the odd glass of wine. 

Have you tried the DSNS taper we go on about all the time?

https://patient.info/forums/discuss/reducing-pred-dead-slow-and-nearly-stop-method-531439

You don't need to "start over" if you flare - that is an unnecessary amount of extra pred. Using the DSNS way you see immediately if you are starting to flare - and go straight back to where you were OK. However - when you repeatedly flare at a given dose it is a sign you have got to the Holy Grail: the lowest dose that manages the inflammation.

If you DO have RA - it is a possibility, late onset RA doesn't always show joint damage for a long time and LORA can present almost identically to PMR - then MTX would be the place they would start. I've come to the conclusion that when people are struggling then trying MTX may well be worth it. But when it stops working or you don't get on well with it - it isn't worth it and you should stop.

 

Thank you all for your very thoughtful-and thought provoking replies.  I will revisit the DSNS taper and see where I want to go from here.  I may try the taper and see how I get along.  The rheumy also suggested supplementing with tylenol to control pain as I tapered - is this an OK idea, or should I stay at a pred dose that keeps me pain free before tapering again.  He does not seem to be very interested in really figuring out what is best for my particular case.  Or really interested at all.  Hard to find a PMR savvy doctor around these parts.  I will keep in touch!  Thanks!

Gayle

There are a few things in your post that are worth teasing out....firstly, as Eileen OFTEN says, the goal is NOT to get off pred as quickly as possible. The goal is to get to the lowest possible dose that treats the symptoms - as long as the PMR is still active.

What are you doing with your diet to help keep your sugars down? (this is a rhetorical question, not one for you to answer here).

You may well have the first signs of LORA, but did you know that MTX is also used as a 'steroid sparer'? In may help you reduce the amount of pred you need to keep your (PMR) symptoms under control.

I started on MXT over a year ago and it worked wonders - I was able to reduce from 20mg (I ws stuck there) down to around 7mg over time. It did take 3 months to really start working. I have NO side effects other than raised liver function tests, which is very normal and are being monitored.

I have also started on Tocilizumab (Actemra) which has helped me further reduce my pred dose, now down to 4mg - 4.5mg. It's prescribed for RA too, but is showing promise to treat both PMR and GCA. Your rhuemy may well being thinking of going down that route - it might pay you to ask him the reasoning behind his treatment, and don't let him fob you off.

 

One of my friends on another site is having to get off of prednisone because she is diabetic and her blood sugars were out of control and after trying for months to fix the problem they put her on methotrexate and have her tapering off prednisone. They also gave her tramadol for the pain. She says it's helping but i don't see how it can.