Prednisone taper and Methotrexate

[JJ2013]

Has anyone taken Methotrexate in addition to Prednisone for PMR? Did you take it to help with prednisone taper?

[PMRpro Ambassador]

Methotrexate is used as what is called as "steroid sparer": it changes the way your body processes the pred and it is claimed that the same result is achieved with a lower dose of pred. The research that has been done has provided mixed results - one study said it helped, one said it didn't, others came to no conclusion. The most recent recommendations in the newest guidelines is that it doesn't help in PMR so there is no point in using it. Many consultants were already adamant there is no role for methotrexate in PMR, definitely not in GCA.

Methotrexate is the first line medication in RA - you start with that, if it works you don't try anything else until its effect fades. It is not uncommon for patients to first be given a diagnosis of PMR but later to have that diagnosis changed to late onset rheumatoid arthritis, it happens for about a fifth of PMR diagnoses. It isn't clear whether the PMR can morph into RA or whether it is merely a wrong diagnosis to start with.

Some of us suspect that the patients for whom it works are in this group. If it works and you have no side effects and are able to get to a lower dose of pred then all well and good. I know some patients found it helped for a while and then it seemed to stop helping. Others have noticed no difference at all. The methotrexate does not replace the pred, you still will need some pred if what you have is PMR. I have come across doctors who do not tell the patients this fact. If that were true - why not start with methotrexate?

Several of us who use the slow reductions with very small drops each time feel that trying this form of reduction can achieve the same result as adding another drug with its potential for side effects. Some doctors use it right at the start and I understand it is standard practice in Germany but they also tend to use a higher dose of pred from the beginning.

[Angela123]

Hi there. I am taking 15mgs MTX along with my Pred which is now down to 6mgs daily. The MTX is once a week. I developed RA in May 2013 and took MTX for 14 weeks but had to stop due to side effects. Tried another DMARD and had the same trouble so took nothing for 3 or 4 months while we considered what to do next. Then in December I woke up unable to move my arms/shoulders - incredible pain and neck too. This carried on each morning and evening and was diagnosed with PMR. After several months of pred the RA returned in my hands and feet so I agreed to try MTX again and happily the side effects are few. I don't know if this will help me reduced the pred quicker or not. My Rheumy says it will eventually replace the pred. I'm down to 6mgs now reducing to 5mgs shortly or at least that is the aim. I don't know if I would have agreed to try MTX if it hadn't been for my RA it's hard to say. I have osteoarthritis also. Angela.

[PMRpro Ambassador in reply to Angela123]

It won't replace the pred for the PMR - not unless the PMR has gone into remission. MTX alone does nothing for PMR, just maybe allows you to get away with a lower dose of pred but even that isn't certain in the long run - the research is contradictory.