Methotrexate together with Pred. 😩

A lot of folks on this site including me have been led to Methotrexate under the guise that it can help one wean off Prednisone.  I have yet to read a single commentary from anyone that this has proven to be true.  Certainly had zero effect in my case.  Beyond that, you are...as the expression goes...robbing Peter to pay Paul.  By this, I mean you are simply trading one drug with side effects for another with side effects.  In the end, we all continue on Prednisone and have added in another drug where you have to monitor your liver carefully.  At that point, I quit Methotrexate cold turkey.

Hi I understand I am now on 10mg pred and 20mg of methotrexate and feel as if I have been pushed into meth, as I do not really understand what this has to do with pmr, but it has been confirmed that I have severe RA.  I really also do not think it is helping me to reduce pred. I got down to 3mg and had a flare so that was when I was put back to ten, also had injection to help.

i go back on the 27th July to see my rhemy and think it's time we discussed my medication, all of a sudden I am having problems with my lungs(now just found nodules) so need anther ct scan, I don't know if this is caused by methotrexate so will have to ask. 

You could refuse until she can provide evidence that this is RA rather than PMR or you could seek a second opinion - or you can try it. Has she explained why she now thinks it may be LORA? And provided tests that back her opinion?

I don't think you need to feel you are being used as a guines pig. It is the first line approach for RA and is also a recognised approach in PMR/GCA to try to reduce the pred dose better/lower than using pred alone although there is no real study evidence that it works: of the 3 studies done, all small and not particulalry powerful, one study said it helped, one said it didn't and one didn't come to a conclusion. The one that found it did help reduce the dose of pred was followed up by the study group 5 years later and then they found that although patients has achieved lower doses using mtx, it didn't change the pred-related side effects - which rather begs the question "Why bother then?". 

In RA it can take up to 6 months before mtx has an effect. In PMR there are no time scales. I recently agreed with my rheumy to try mtx because I have had PMR for 14 years and have been on pred for 9 years now. I have always rejected the concept - because I believe it is just as possible to reduce the pred dose by using the slow approaches though it probably isn't as fast as the average rheumy would like! - but more recently I have felt that it is probably worth trying it PROVIDING IT DOESN'T MAKE YOU FEEL WORSE!!!

Unlike Daniel I do know people who have tried mtx and it helped them get to lower doses of pred - they know it helped because when they tried stopping the mtx they had significant increases in pain. One friend, heavily involved with the Scottish PMRGCA charity, was on mtx with absolutely no side effects for a few years and it did get her to a lower dose. Last year though they decided to try lefflunomide and she says she felt it "kick in" and within 8 months she was totally off pred. She also had no side effects from the leflunomide. 

I, on the other hand, tried mtx for 4 weeks in June. The first week was fine - I had no nausea which is one of the really common effects. I had a bit of abdominal cramp and was a bit "loose" that first week - and that was worse the second week. I didn't have diarrhoea but when I needed to go - I needed to go! It really wasn't conducive to being out and about! I took the mtx on Saturday night and Sunday morning and about Wednesday I developed a headache - I never have headaches - which lasted to Friday night. That persisted each week, as did general aches just like PMR and itching. By the end of the second week I was feeling tired - and by the end of the 4th week the fatigue was overwhelming. I actually felt as bad if not worse than I did in the 5 years of PMR without pred! I had already told the rheumy I would stop it while we had a trip to S Korea for a week for a meeting. By the time we left on the Thursday I felt so much better and managed the flights well. Had I still been on the mtx I don't think it would have been possible. I haven't started it again and can now walk into the village normally - which I couldn't on mtx.

About a third of patients can't tolerate mtx and stop because of the side effects. That is even in RA where it does play a very important role. It is personal decision, I decided to try it but I really can't see the point of taking a drug that makes me feel as I did without pred at all. Now to break that to the rheumy!