Methotrexate........ friend or foe.

[cynbil]

I am due to see my Rheumy next week and I know they want to start me on Methotrexate, I am not sure what to do. Can I ask you wonderful people what should I do. I am going through a flair and I feel dreadful and having severe problems walking now using two sticks but still struggling the pain in my leg and left shoulder is getting me down. I also believe that I will be having my right hip replaced some time this summer. Any advise would be greatly appreciated. Thank you Cynbil ( Cynthia) x x

[tomasina]

Hello Cynbil,

Sorry to hear of your problems. It would help if we knew how much Prednisolone you are taking at the moment. I commenced on Methotrexate 15mgs. last year, and I was also taking 10mgs. Prednisolone. I did not find it was steroid sparing as I still continued with the Prednisolone reducing 1mg. per month. When I got down to zero on Pred. I was still taking 10mgs. Methotrexate and had a flare up after three months, and then up to 10mgs. Prednisolone again, with good result. Quite honestly I did not find any difference with Methotrexate and my Prednisolone reduction was the same as without Methotrexate. I am now off Methotrexate and have got to 5mgs. Prednisolone daily. Fingers crossed all will be well. Have a good discussion with your Rheumatologist. Then decide. Best wishes Tomasina x

[bowler]

Hello cynbil

Methotrexate didn't suit me, and I had to stop them. Everyone reacts differently to most drugs, so the choice will be yours alone. You could start them and see how things go, and as you are in so much pain you have nothing to lose, and you can always stop them if they dont suit.

I wish you luck.

bowler

[PMRpro Ambassador]

Is it a flare or is it bursitis in the hip and shoulder? If your hip problem is osteoarthritis and you are that bad - why hasn't your hip op been brought forward? The UK NHS is in a mess but most units would rather do hip replacement before the patient gets too immobile, they recover better. One lady I know was told by her GP she would have to wait years as she was barely 60 - I told her that was rubbish and to push for a consultant appointment. She went to see an orthopod privately - but was immediately transferred to his NHS list and the op was done in a few months. The people I know who had difficulty reducing found the reduction post-hip op was much simpler.

I personally would not take methotrexate - there remains little evidence that it works in simple PMR, the studies are contradictory and the most recent recommendations are that it doesn't help. I (and others) believe when it does work it is because it is not simple PMR but late onset rheumatoid arthritis that has been misdiagnosed. As Tomasina says, a VERY slow reduction works just as well in many cases - without the risk of the side effects of methotrexate.

I reduce by 1mg every 5 weeks or so - I take the new dose on one day, old dose 6 days, new dose 1 day, old dose 5 days and so on, reducing the no of days at the old dose by one each time until I get to alternate days old/new and then increase the days of new dose between a day of old dose until I get to 5 days new dose, one day old. Then I take the plunge to every day new dose. Doing that I have got from 15mg to 5mgs with no problems at all - having never managed to get below 9mg before.