Methotrexate

You will get better people than me to tell you about MTX. 

As regards the hunger, I went through the same thing, couldn't get enough food. I would suggest reading up on carbohydrates. The way carbs convert to sugar to give a short energy boost but then soon the insulin levels stop this and convert the extra sugar to fat. Then you're hungry again. Lowering you're carb intake seems to be the best way to go. Hope this helps a little. 

Ron

why change if it is working ( as you said - have little to no pain and stiffness.)? Every drug has side effect.. If waight gain is what you are worried about, change a diet to less carb and increase your activity level. Reduced activity is main contributor to  you gaining weight.  Some people reported chaging to Methotrexate only as a last resort to try to reduce pred dosage, not as a replacement. 

Your Rheumy seems fixated on age, you are in the range. I was 53, but others here have been in late 40s. 

I was on Pred for about 8 months then she added Plaquenil and then Sulfasalazine .  I'm still in pain every day. I'm down to 4 mg Pred but in more pain in morning and late evening, but I refuse to go up. Pred has done a number on my body.  I really don't think the DMARDS help me at all.  I show no RA markers.  The Pred got my SED rate down after a few months from 80, down to 6 now, but been 1 1/2 years. 

Yes...one must fall in love with salad, greens, veggies, olive oil.  I did not gain weight and only get hungry if I cheat and eat some flour or sugar food. 

What helped me at first was cooking chopped up veggies and put them on top of the spinach and/or finely chopped kale. Fruits only in morning and with protein, otherwise fruits affect me.

Also, do light weights with the muscles unaffected if you can. Pred really ate away my other muscles, but I have nice biceps, Hee, Hee.

good luck. Bless your heart. We all understand. 

Did your pain respond within hours or prerhaps a couple of days to pred?  If so, and other causes were ruled out as much as possible, you most likely have PMR.  There is no reason at all to consider switching to another drug this early on in your treatment.  That is a tactic usually reserved for those few who find it impossible to reduce the pred for many many months, or who have a sensitivity to pred. Dropping to 11 from 15 is very likely to cause a flare in your symptoms.  More gradual tapering is recommended.  And even if your doctor is wanting you to "switch" to mtx you can't do that at this point without tapering the pred anyway.  The recommendation is never to drop more than 10% of the dose at a time, and the lower your dose, the slower the taper should be.  So from 15 mg you should not be dropping more than 1.5 mg for a week.  And after that no more than 1 mg.  By the time you are at 12.5 or 10 or something like that, you'll be best advised to slow the taper down so that it takes several weeks to achieve a drop of 1 mg.  It has often been said on the forum that it isn't slow if it works.  The forum is full of people who were advised to drop too quickly and have had flares and ended up often having more difficulty reducing - so very slow and steady is the key to successful tapering.  

Others will be along with more complete advice about how to handle a successful taper - and how to handle the overeager rheumatologist.  

Tastyron and Nick have great advice about the weight issues.  You may end up feeling like a rabbit, but eating a lot of vegetables especially leafy greens, things that require a lot of chewing, can be very satisfying and will cut down on your food cravings.  And now that you feel better, appropriate exercise will help - just be careful not to overdo it, your muscles will be weakened by the pred itself, and the autoimmune disease means you really have to be kind to yourself.  But the right amount and kind of exercise is important and will help no end!  Good luck!

Your rheumy is obviously NOT convinced that it is PMR you have.  Otherwise he wouldn't be using the pred/methotrexate the way he is suggesting.

Pred is the mainstay of management of PMR - and by that, I mean it is the only available drug that works reliably. Some rheumies like to use it as a steroid sparer - it changes the way your body processes pred and for some people they are then able to get the same effect with a lower dose. But it is very rare that the MTX alone manages PMR - I don't think I know anyone who has got off pred altogether - they have taken the MTX as well as pred but have been able to reduce the dose of pred to much lower. But it doesn't work like that for everyone with PMR.

MTX is normally used for RA - and since late onset RA and PMR can present identically possibly your rheumy thinks that may be the case. 

If you follow this link and look halfway down the first post 

https://patient.info/forums/discuss/pmr-gca-website-addresses-and-resources-35316

you will see a heading

[color=#3a2e28]2015 Recommendations for the Management of Polymyalgia Rheumatica - a EULAR/ACR collaboration[/color]

follow the link and look at Recommendation 7

I don't know if you can understand the medical-speak - but there is not any really good evidence it works so could be tried if the patient is happy about it and it may help. My line is that if you don't suffer side effects (and like all drugs it has some) it is worth trying. I do know a couple of people who have been able to reduce their pred dose a lot. i know others for whom it allowed a reduction in dose - and then it resulted in a major flare. You can't tell which you will be in advance. You don't know until you try if you will be able to reduce. Many people have reduced using the slow reduction you will find in the replies to that thread I gave you the link for - without MTX.

What is fairly certain is that a reduction of 4mg in one go will almost certainly lead to a flare at this stage - and you have been long enough on above 10mg for there to already be adrenal suppression so I hope he isn't going to stop the pred from 11mg to zero overnight as that could add in other problems. 

Weight gain - cut your carbs, it has helped a lot of people avoid weight gain or let them lose weight - I lost 38lbs and have recently been back to 15mg due to a flare with no weight gain . Except that is when I was at a meeting in Canada and ate carbs - when I put on 4lbs in 10 days - which have all gone again now I'm back to normal eating for me! 

As Eileen says pred is the main drug if you do have PMR. Many people are also given Methotrexate in conjunction with pred as it is thought that it might help reduce the pred dose. Although I believe the jury is still out on this.  I am not sure I would consider taking Methotrexate without pred for PMR at the level you are currently on. Again as Eileen says if you had Rheumatoid Arthritis that would be totally different and Methotrexate could be a good option.

I know the hunger problem I was ravenous although it is a bit better now. I could have eaten a five course meal followed by another five course meal! 

Have you had your CRP blood level checked as well as sed rate? It is now thought it gives a better feel for inflammation. I normally have both checked every time I have blood tests.

Eileen has it right, as usual! Take heed when she speaks! lol

If the pred worked, it's fairly certain you have PMR.

I'm on MXT - and what I would consider a 'success'. BUT, I'm not off pred and don't expect to be any time soon. What MXT has allowed me to do is drop my dose from 20mg to 5mg in a matter of 6 months. I'd been stuck at 20mg for months and months and it was making me sick.

Hi Mirella

I am about to start methotrexate next week and posted about this this week.  I have enclosed the link in case you didn't see it, as I had some really helpful replies.  Hope it helps you too.

Louisa

https://patient.info/forums/discuss/i-am-being-recommended-to-go-on-methotrexate-to-mitigate-steroids-515099