Medication change

Posted , 12 users are following.

Hi, I have seen Rheumatologist this morning and they want to add om Methotrexate and gradually reduce the prednisone- currently taking 18.75mgs of prednisone but still sore for at least 2 hours- any advice please 

1 like, 11 replies

11 Replies

  • Posted

    How long have you been taking prednisone?  At what dose did you start? How do you take .75? (18.75 is a mighty high dose)  Please advise.

     

    • Posted

      Hi, I started on 15mgs and took for 2wks but still sore so Dr increased to 20mgs and have taken that for 7wks and reduced down to 18.75mgs a week ago
    • Posted

      If you have PMR there is no reason why you should be taking another medication after such a short time.   Is PMR your diagnosis?
    • Posted

      I am on 8.5mg and have started to reduce by .25mg as my body accepts the drop more easily as I am steroid sensitive.  I cut a 1mg pill in half with a pill cutter and then cut the halves into quarters on a board using a sharp knife. Pretty accurate and works every time as the pills aren't crumbly.

  • Posted

    Adding Methotrexate is usually done after year or two  and at best it has mixed results. After only several weeks on pred, it is crazy. When you say "still sore", how does it compare to initial pain you had when you were diagnosed. Even more important, how does it compare to the level of pain you had when you were on 20mg? Many people have some residual pain, and live with ~70% reduction in pain.

    • Posted

      They reckon taken Methotrexate at the very start has better results than starting well after diagnosis. A friend had excellent results with Methotrexate which she started with the pred and got off pred in two years with no flares.
    • Posted

      Oh yes, I'd forgotten that theory.  Perhaps that's what's going on here.  Should have kept my mouth shut!

  • Posted

    If the soreness is in the early morning that is perfectly normal - that is when the new batch of inflammatory substances is shed and until you take your pred dose and it takes effect you are likley to be sore and stiff. That has nothing to do with the effectiveness of the pred and to me it seems crackers to introduce another medication which has its own set of side effects and which isn't guaranteed to make any difference to how the pred works for YOU at this stage. I would want to try reducing alone, slowly, as long as I could. Many people do get to lower doses realtively easily providing they aren't rushed.

    An Italian study found that although adding methotrexate did allow some patients to get to a lower dose of pred initially, I don't think the overall dose of pred wasn't sigificantly changed but, above all, there was no change in the incidence of pred side effects which is claimed to be the reasoning behind using mtx. And whether patients were put on mtx or not - PMR still required pred for up to 6 years. 

    • Posted

      Thinking about appt today I also developed a superficial DVT beside knee yesterday and Dr wonders if I have maybe a seronegative RA in some area also
    • Posted

      In which case adding methotrexate would be a natural first step - it is the first line approach for RA. In the UK at least you have to work through a list of DMARDs before you can be considered for a biologic and I think that may also be the case for some US insurance plans.

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