Tapering prednisone with methotrexate

[arvine]

took my first methotrexate injection 15 mgs today, been on 4 mgs pred since May, whst sre opinions of starting taper to 3 1/2 mgs now?

[Hidden]

Advice on your situation:

1. Give methotrexate time:

Methotrexate does not work immediately. It takes between 6 and 12 weeks to start effectively controlling inflammation. In the meantime, prednisone is still key to keeping your symptoms under control.

Do not reduce your prednisone dose too quickly until methotrexate has had time to take effect.

2. Taper prednisone slowly:

You’re already on a low dose of 4 mg, which is a good sign. However, reducing below 5 mg requires caution because the adrenal glands (which produce cortisol) may still be "asleep" due to prolonged prednisone use.

How to reduce: Lower the dose by just 0.5 mg at a time, and stay on the new dose for at least 2 to 4 weeks before reducing further. This allows your body to adjust safely.

3. Pay attention to your body:

If you decide to reduce to 3.5 mg, monitor yourself for any signs that your condition is flaring, such as pain, stiffness, or fatigue. If these occur, stop the taper and consult your doctor.

Watch out for other symptoms like weakness, dizziness, or nausea, which could indicate your body is struggling to adjust (adrenal insufficiency).

4. Always consult your doctor:

Even if you feel ready to reduce your dose, your doctor is the best person to advise you. They can confirm whether this is the right time to taper or if it’s better to wait until methotrexate has been in your system for longer.

5. Be patient with the process:

Tapering prednisone is a slow process, especially at low doses. This is normal and helps avoid relapses or side effects. Your long-term health is the priority.

Simple summary:

Can you reduce to 3.5 mg? Yes, but do it gradually and pay attention to how you feel.

Wait: At least 2–4 weeks before making further adjustments.

Consult: Always discuss your plan with your specialist before making changes.

Remember, the goal is to maintain control of your condition without rushing. You’re on the right track!

Good luck 👍🙏

[arvine in reply to Hidden]

Thank you yes I know metho takes time but honestly dont think 4 mgs has been keeping inflammation and pain under control, reduced to that dose since May, , and every part of body has gradually got worse joints muscles etc since end of June, I have breakdowns almost daily with pain,especially first few hrs of day, have had help all week from my guy, long distance relationship for years, lives 2 1/2 hrs away, but can barely manage simple things daily, making bef shower, dishes etc, big breakdown this morning hirt so bad, as I have said on this site many times rheumy doesnt think I have pmr anymore just osteoarthritis and continues to advise a taper, wanted to try the 5 mg increase for a week or two see if helped he is dead set against me doong that,, Ive been patient , had 6 sessions nerve blocks, didnt help anything, Im truly at end of rope, he had given me 6 weeks of metho injections and folic acid, Im just a mess and know metho takes long time if it s going to help me, sorry for long rant just done in this morning

[arvine]

Thanks so much for understanding, and your words of advice, I have thought for while about getting 2 nd opinion , just takes so long to get new rheumy, have been trying some of your suggestiond ie hot morning shower, stretches before getting out if bef, etc, Ive only had one injection of metho 15 mgs yesterday, took one 1 mg folic acid today as instructed, still tempted to increase prednisone by 5 mgs for week or so but fear rheumy would discharge me or potential consequences trying to go back to current dose of 4?mgs, also may interfere with methotrexate dose? I knoe need to run by drs but hesitant as both GP and rheumy want me off prednisone

[arvine]

Thank so much , all good advice,appreciate