Long suffering

[michaelegan]

I have had PMR for six years. I now have osteoarthritis, serum negative rheumatoid arthritis, osteoporosis. Is methotrexate any good ?

[PMRpro Ambassador]

If you have serum negative RA I'd have thought they would have tried methotrexate before since it is the first line approach for RA.

In terms of PMR, the evidence it helps reduce the pred dose you need is mixed. One study said it does, one study said it didn't, one said it didn't know. Quite a few rheumies do use it, I gather it is used from the start in Germany alongside pred but I don't know how successful it is. The most recent guidelines in the UK say it probably isn't of use.

Some people think it helps in patients who have been misdiagnosed as having PMR when it is actually another arthritis, often LORA (late onset RA). Pred is sometimes used for RA, especially in flares, but other drugs are better. About 1 in 6 patients who are first of all given a diagnosis of PMR have it changed at some later point - and those patients may well benefit from methotrexate. Since they have told you you have seronegative RA I would think it would be worth trying. It takes a few months for the effect to really set in and if it isn't making you feel ill (like everything else it has side effects) it might well be worth it. I know a few people for whom it worked well and a few for whom it did nothing. You only know when you try.

[lesm]

My mum has now been on methotrexate a year past on October (11mg), she has managed to come down to 2 mg of predis (the lowest she has managed before was 4mg). Unfortunately, she suffers with diarrhoea shortly after taking the methotrexate and the rhematologist talked to her at her last visit about injecting this. Her Gp is actually against her being on this medication so she is unsure what go do for the best & is even considering discussing coming off it. Mum has also had PMR for approx 6 year. Best wishes to you

[Sallyaches]

I am taking methotrexate by injection and my main side effect is a slightly sore mouth. The injection is once a week and via a medipen device. I can not advise wether the treatment is right for you but just want to say its nothing to be scared of . I know it is not mainstream treatment for PMR and you will need more frequent blood tests but in your individual case it may be a good treatment for you. If it is of no benefit or the side effects are too bad you can always stop after giving it a good try.

Good luck

[PMRpro Ambassador in reply to Sallyaches]

Sounds as if you may not be on enough folic acid Sally - they give a standard dose I suspect and if it isn't enough it is worth asking to try more.

[michaelegan in reply to Sallyaches]

Thanks Sallyaches