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Methotrexate . . . What is that?

Posted , 13 users are following.

davidmelville
davidmelville

I've posted before so will do the very potted history . . . .

It's now two years since first diagnosed with Polymyalgia Rheumatica and the first Prednisolone which was like a miracle and I guess still would be if I 'overdosed'. Currently well stuck at 10mg there seems no way forward. I've tried the slow tapper but the first day I drop there is a reaction so I had decided to just take a quiet view and stick at 10mg until the new year and then try the slow taper again.

I'm not uncomfortable at this level and it does not worry me to stay at this level.

But, the Hospital called today as there was a cancelation and I was overdue to see the Consultant. Chatted over my position and he expressed concern that I had become steroid dependant, something that can happen after two years. Whilst the dependency was not something that concerned him in itself it did however at the 10mg level. Get to 5mg 'ish and that would be more acceptable.

So he wants me to go on Methotrexate, starting with a three month course running alongside the 10mg of Prednisolone. This is to be closely monitored by a 'specialist' under one if the consultants (can't remember for what) and will mean blood test one or twice a week. Then after another Rhumi appointment in three months a decision will be made to start lowering the Prednisolone.

The whole thing seems horrific, especially as I have just noticed in an article on this site the following 'There is little evidence for the efficacy of steroid-sparing agents - eg, methotrexate or anti-tumour necrosis factor agents. Methotrexate is the most commonly used corticosteroid sparing agent.'

Any comments and thoughts will be appreciated. 

2 likes, 53 replies

53 Replies

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  • cat_lady_66
    cat_lady_66 davidmelville

    Posted

    Hi David I have PMR and Psoriatic Arthritis and take prednisalone and I inject every week 25mg of Methertrexate, as long as you have the  blood tests as required for the first months and all is ok, you to monthly bloods and I am now every 3 months, and have been for years and years........

    Doing tins keeps my PMR and Psoriatic Arthritis under some form of control, and when I get very back flare ups we increase the prednisalone ,  most of the time I feel ok nut some side effects......they are manageable, the blood tests show if all is ok.....

    Good luck cat lady 66

    • cat_lady_66
      cat_lady_66 davidmelville

      Posted

      Oh sorry yes, I took tablets for about 12 years, but now inject but you don't have too do this tablets are fine .....keep in touch ....and let me know how you get on....
    • davidmelville
      davidmelville cat_lady_66

      Posted

      Thanks, so were you able to lower your Prednisolone as a result of taking the Methotrexate and may I ask what you are on now . . .
    • cat_lady_66
      cat_lady_66 davidmelville

      Posted

      I now take 25 mg of Methertrexate  each week and a maintainence dose of 5 mg  Prednisalone  per day I am going to see my consultant at the end of September and ask to slowly stop the preds and see what happens.........I hope you will be ok...keep in touch....Good Luck         Please feel free to aske any questions you may have, I will try and help by telling you how I,feel and what I did, but remember all meds don't agree with all people....... There are,lots of combinations and lots of meds that can help you.    
  • cat_lady_66
    cat_lady_66 davidmelville

    Posted

    Sorry for the mistakes, my IPad is very sensitive this evening for some reason, or may be it's the typist Ha haa.     Cat Lady
  • debbie27473
    debbie27473 davidmelville

    Posted

    Hi.

    I had to respond, as I am in a very similar position to yourself. At my last monthly gp check up, my doctor referred me to a rheumatologist as she is concerned that I cant get my pred dose below 13.5mg  She said the rheumatologist would be able to prescribe me Methotrexate to allow me to reduce my steroid intake. Like you, I have heard mixed reviews about this drug and since I already suffer horrible side effects from the pred, I am somewhat concerned that there seems to be no concerted opinion as to whether it is effective! I shall be reading your responses with great interest. Good luck and please keep us up to date with your progress. Debbie

    • davidmelville
      davidmelville debbie27473

      Posted

      Hi Debbie, fortunately I have a brilliant, cooperative doctor who I am going to see and discuss it with in full. We agree IRS my body and my discussion., but I'm not stupid about that just carefull. 

      I was recently offered the 'shingles' jab but after chats on this forum and exploring the drug companies own comments I opted out . . . after all it is a live vaccine! My point is that the surgery was all Ozk fir me to gave it despite my misgivings but I just felt not this time.

      Guess I feel the same about the Methotrexate no point in doing it if I can reduce the Prednisolone and then don't want to sustitute a new drug to add to my list.

      What a minefield . . . .

    • bedilia
      bedilia davidmelville

      Posted

      Hi David.  I too have a LONG history of steriod use, and so this time, when I was put on Prenisone for my new dx of PMR, I had a horrible reaction to the steriod.  I actually became "psychotic"!  I called my PMD, who is much like yours, and he agreed to my titrating down even quicker, on the dose.  

      Anyway, I got down to 1mg.  When I saw him last Thursday, he told me I was on a "homeopathic" dose and should just go ahead and stop the Prednisone.  I feel so much better off this wicked drug!   He did mention using one of the steriod sparing drugs if my sx got so bad I needed something other than my current pain management regime.  My PMR sx's have increased a little, but I want to wait before I jump on that ship again!  

      He did tell me a consult with a rheumy wouldn't be miss.  I will probably go to the one I saw 10 years ago.  I am just trying to regroup since this last experience before I do anything!  

      I too am not stupid...just careful.  I do have 42+ years as a critical care RN under my belt so that helps me make fully informed decisions!  

      Christine in So. California, USA 

    • davidmelville
      davidmelville bedilia

      Posted

      Thank you. I so appreciate all the info and always have . . . part of my problem from the start is wanting to be part of the process and with too man voices it is easy to get deflected and make wrong decisions. I know I have done so and looking back could have taken a much better path. If I had used the slow taper from the start I could well have been clear by now but it was the urgency to get off the steroids that always spoilt things. Constantly being told to get off them as quick as possible whilst true must also be feasible.

      thank you . . .

  • debbie27473
    debbie27473 davidmelville

    Posted

    I know exactly whatyou mean about the drug list! I have been suffering awful acid reflux as a result of the pred and now have to take Omeprazole every night to keep it at bay. I am now getting attacks of vertigo, nausea and a return of swollen ankles (also originally from the pred,for which I have been prescribed diuretics that had been working). Guess what? All side effects of Omeprazole! I am now wondering if the doctor will want to prescribe more tablets to control the side effects of the tablets she has given me to control the original side effects! Where does it end? You have to laugh (albeit somewhat manically)!
    • davidmelville
      davidmelville debbie27473

      Posted

      Now I like omeprazole . . . It's my friend. Acid reflux in the night started long before Polymyalgia Rheumatica and Omeprazole was my saviour, once I found out what foods caused it. I take one in the morning and one in the evening just to lower acid and line my stomach all with no side effects that I know about. For me it comes under the old saying "you are what you eat"  and some foods after 4pm are strictly out.
    • debbie27473
      debbie27473 davidmelville

      Posted

      I would be very interested in which foods you are referring to. I have been trying without success to find my acid reflux trigger. The only thing i noted before my last attack (Monday just gone) was I had not eaten as much fruit and veg for the few days preceeding. I have already drastically reduced my intake of white flour products and processed, pre-packaged food to try (unsuccessfully so far) to combat the steroid weight gain, especially neck and midriff areas. Yes Omeprazole is a friend but like the lovely rose, it has thorns lol!
    • EileenH
      EileenH debbie27473

      Posted

      Debbie - if you are having severe side effects from the omeprazole ask your GP to change the type of anti-acid medication. There are other PPIs (omeprazole is a PPI) which may disagree with you less or you can use good old-fashioned ranatidine (Zantac) which is a different substance group. Gastroenterologists have expressed surprise at the GP fixation with PPIs when ranatidine would work as well with fewer side effects.
  • ptolemy
    ptolemy davidmelville

    Posted

    I have had the most awful swollen ankles and also my feet look like something out of a horror film, someone one on this forum recommended Manual Lymphatic Drainage and I have found it fantastic. The downside is you have to pay for it!
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