Newbie struggling with decreasing Prednisone!

A couple of other ladies in the UK lost weight using Weight Watchers - but they too stuck strictly to their guidelines for diet. It can be done but you have to do your part - it won't be easy-peasy weight loss.

Does Methotrexate actually agrees with you?

i am also new to forum.    However, I was diagnosed with PMR in August 2013.   There are many great discussions in this forum that will help you.   Try to read as many as you can.

The most consistent advice that I can share is that Predisone really helps with the pain.   I was on methotrexate for a short time but had severe reaction to it.   But, that was just me,   All good rheumys want to help us reduce the amount of Predisone, mine included.    But, this is done over a very long time.   For many, this is years.  Please, try to consider this a longer term treatment.   Most of us are doing great on a regular dose of Predisone (versus the pain of PMR).

My PMR treatment started with 20 mg of predinsone, which is quite common.     It took many months of moderate reduction (which meant no pain) to get down to 10 mg.    Some have told me on this forum that was very fast.    The point is that the initial strong dose for a period of maybe weeks, or less, is important.   

Some of us think that the patients for whom MTX works may well not have just PMR but have been mis-diagnosed with late-onset RA (LORA) which isn't uncommon. It is absolutely certain that if what you have is PMR, then MTX on its own will NOT be a successful approach to pain relief. If it were - it would be used instead of pred much more often. It isn't. 

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

If you follow this link you will come to a post on this site which has several further links. One is to a paper by one of the top PMR groups in the UK with their approach to managing PMR and GCA. They describe their reduciton plan - it does not include any use of MTX but is a fairly slow reduction. They keep patients at 15mg for 6 weeks and 12.5mg for a further 6 weeks before leaving the patient at 10mg for a year. It results in a flare rate of 1 in 5 rather than the more common 3 in 5. The vast majority of flares are due to reducing the pred dose too fast and too far. On their approach you would currently be on 10mg and that does appear to be right for you at present. The inflammation must be eradicated and then prevented from returning by an adequate dose of pred. PMR is the name given to the symptoms of an underlying autoimmune disorder - and until that burns out you will need some pred. The reduction is to find the lowest dose that will manage the symptoms. This UK group have obviously found they get fewer flares by sticking at 10mg for a long time - but many patients do manage to reduce further sooner providing the reduction steps are much smoother and spread out.

Below 10mg reductions must be in far smaller steps - the basic rule should be not more than 10% of the current dose, so 1mg, reducing to 1/2mg steps as time goes on. Several of us have developed slow reductions, spread over a few weeks, using 1mg drops to save cutting tablets. These seem to allow a lower dose to be achieved sooner than 15 months after the start as the paper I mentioned proposes. It becomes a question of trial - if it works, fine, if it doesn't you return to the dose that did work. There is a detailed description further on in the link I gave you, posts 4 and 5 I think.

The use of alternate day doses as your rheumy is suggesting is not recommended in PMR - it rarely works. I used it for a while but at a much higher level and was never able to reduce below 18mg/2 days. It depends on you being one of the people for whom the anti-inflammatory effect of pred lasts the maximum amount of time. The effect lasts for between 12 and 36 hours or so - if your window is under 24 hours, then taking the dose every second day allows the inflammation to resurge every other day and probably requiring more pred to get it under control again.

The first link in the link I gave is to a support site from a group in the NE of England where you will find the British Society of Rheumatologists guidelines, they are not so different from the US guidelines. There a link to this paper I have discussed and to another review paper on management of PMR. None use MTX as a first line approach and most of them won't include it any longer as a second line approach. If your rheumy is not prepared to discuss adopting what is considered best practice for management of PMR, then I would suggest you seek one who is. Pred remains the gold standard therapy for PMR - whether doctors like it or not. It works well and used properly allows a good quality of life. But it depends on you being on an adequate dose - if the dose is too low you might as well not take any at all.