Metotrexate again
Posted , 11 users are following.
My dr wants me to start taking Methotrexate again to reduce the prednisone. I quit it awhile back under her agreement. Well, I looked up the word on this forum and this is what Eileen had to say about the dr who gave it to me then:
Pred is the drug of choice for PMR - and methotrexate does not do anything for PMR pain. In some people - and by no means all - it changes the way the body processes pred so that you get the same effect for a lower dose - or a better effect for the same dose whichever way you like to look at it.
Yes, the silly man IS missing something: you have PMR where the underlying autoimmune disorder is still active and he hasn't cleared out the existing inflammation properly before trying to reduce the dose you are on. Until that has gone altogether you can't find a lower dose that will clear out that new daily amount of inflammation that is characteristic of PMR. It's like a bucket of water with water flowing into it through a pipe into the bottom: you can scoop out a bit of the water every so often and it wont overflow for a while but the only way to sort it out is to empty the bucket of water and close off the pipe. In PMR you need long enough at high enough to clear out the inflammation - and then you can reduce to a much lower dose since all it has to do is deal with one day at a time!
You need a new doctor who CAN see the wood for the trees - this one doesn't
Eileen is this still true of methotrexate? I did get down to 13mg pred at that time, so maybe it did help. Now I can't get down past 19 without hurting too much.
1 like, 9 replies
EileenH DebbieHurts
Posted
Are you in the US? Has he mentioned Actemra?
DebbieHurts
Posted
I'm in the US. My dr hasn't mentioned Actmera. Should I mention it to her? Does it take the place of prednisone? I'll go look it up. Thanks.
Anhaga DebbieHurts
Posted
You say you got down to 13. But now you say you can't get lower than 19. What happened? After you stopped the mtx what happened? Why are you 6 mg higher than you were when you stopped mtx? Why did you stop mtx?
Actemra is still used in conjunction with pred, but it does appear to enable people to get to a really low dose. I don't know if it's been determined yet whether it can eventually replace pred altogether, but at the moment patients still take pred even if starting Actemra really early on. In GCA it sounds like they still don't trust it completely. We know pred can save eyesight and I gather there is still some caution regarding not using pred at all, as maybe no one knows the risks to eyesight. I think a number of people have posted in this forum about being able to taper successfully after going on Actemra although they'd had a lot of trouble before, Again, I haven't heard if they've been able to discontinue pred altogether, but Actemra should shorten the duration of GCA and/or PMR. I know Eileen knows a lot more and she'll correct any misinformation I might inadvertently be passing on.
EileenH DebbieHurts
Posted
jan_37704 EileenH
Posted
EileenH jan_37704
Posted
In RA it is said to take up to 6 months to make a difference. In the case of PMR it won't make a difference to the PMR itself but it may allow you to reduce the dose of pred further than you have been able to before. However - there are no guarantees of that and it was said in the original study it takes up to a year to observe an effect.
I'm assuming if you say you have peripheral joint pain your doctor thinks it may not be PMR? Joint pain isn't really common in PMR.
jan_37704 EileenH
Posted
EileenH jan_37704
Posted
How all very strange - I wonder what makes him suspect GCA? They do overlap - you might find this interesting:
https://academic.oup.com/rheumatology/article/56/4/506/2631560
jan_37704 EileenH
Posted
Thanks for article - not been good on 60mgs and supposed to go to 40 a couple of days ago but didn't. Took 50 this am and off for bloods and will call Rheumy tnrw. CT of body and apparently vessels is on 10th May - can't come soon enough - will keep in touch - thanks Jan