Change of meds.

Methotrexate did me no favours.. i know everyone is different, so this is just what happened to me.. I was told it would be weeks before it worked, so I kept taking seven tablets every week.. at this time I was on 16 mgs of pres, dropping from 60mgs , started end Sept with GCA and then PMR. .Five months in, and if I slept more than an hour and a half, that was good!!. My hair started falling out and eyebrows disappeared, eyelashes stayed.. skin was breaking continually, to the stadge the soles of my feet bled continually....anxiety reared its ugly head....didn't like this at alll... three weeks ago I stopped taking it... down to ten now, and going one mg a month if I can.... lifre has become happy again.. I feel one hundred per cent better....I was blaming pred, but not, was I wrong.... sorry if this scares you, but that's just what happened to me, and it certainly didn't help me lessen steroids..... good luck with it.xx

Methotrexate MAY (and I emphasise MAY) help you manage on a lower dose of pred as it changes the way the body processes pred and potentiates the effect. No guarantees though - I don't care what any rheumy says. Mary has told her story.

Whatever your rheumy thinks, 2 years for PMR is the exception and not the rule. A study by an Italian group showed that while using methotrexate got patients to a lower dose of pred, it did nothing to change the incidence of pred-related side effects and whether the patients were on it or not, one third of patients still required pred after 6 years. 

I have been on steroids for 8 years. Three different sorts and for a lot of the time at above 10mg. It was well over 3 years before I managed to get below 10mg and in the meantime had been on prednisolone (almost no problems) and methyl prednisolone (horrible side effects). I was switched to a new form of prednisone - all the methylpred side effects disappeared, I lost all the weight I had gained, and have no problem at all. My bone density has barely changed over 7 years despite only ever having taken calcium and vit D supplements, nothing else. No raised blood sugar, no skin problems, cholesterol a bit high but no-one here cares.

The international guidelines suggest methotrexate MAY be used IN AGREEMENT WITH THE PATIENT - no guarantees. Some doctors will tell patients they will get off pred - not necessarily. It does not replace pred, it might make it work better. Or not. And it adds another potential layer of side effects. I have a friend who takes it, has the occasional glass of wine and is perfectly OK. She is sure it lets her manage with a lower dose of pred - but is still at 7mg.

It is your choice - my view it is probably worth trying if it doesn't make you feel ill. It might get your pred dose lower. But equally - so might patience and the Dead Slow reduction approach. And if methotrexate makes you feel ill - I can't see the point.

I had been giving myself a weekly shot of 15mgs mtx for 14 weeks before I realized that it was causing worse side effects then the PMR without Prednisone.I was really ill for 4 or 5 days of the week.. I didn't realize it was the mtx because I couldn't imagine why they would prescribe it for PMR if the side effects were worse than the PMR itself. I guess as Eileen says, everyone has a different response to it. For me, it wasn't worth it, so far I've just skipped a week, but I'm tapering dead slowly , just started introducing 6 mgs , and keeping my fingers crossed.

Maybe at 10 mg of Methotrexate, you won't have bad side effects. They say it is anesthesia 6 to 12 weeks to kick in but the side effects, if they come, will come right away and, at least in my experience, won't get better with time.

I was labeled "steroid resistant" from the beginning but I think I was just confused about tapering, overdoing , etc.. At least you will be monitored with blood tests every two weeks...I was not offered anything like that and those side effects were brutal and very scarey. But good thing is, you can always go off of it and feel your normal PMR-self again.Like Eileen says, it is worth trying, I think if no major side effects, it may work to make the tapering easier.

How different we all are. When I was diagnosed with PMR I decided against using steroids and was prescribed 15mg of methotrexate with folic acid. It took several weeks to kick in before I started to respond. I had limited side effects - mainly nausea and tiredness but not often. Two and a half years on I have my life back and I'm off the drugs. My consultant is convinced I had PMR and has other patients for whom methotrexate has proved satisfactory. I know this conflicts with other views and research but I can only explain my own experience.