Methotrexate and GCA

[JanetGarrettN]

Sharing an article from Medpage (USA) January 29, 2019:

medpagetoday.com/rheumatolo...

[Marijo1951]

I can only go by my own experience which I know is different from others. I started on mtx after Christmas 2017, so I've been taking it for 13 months. I had had 2 serious flares of GCA symptoms when tapering to 25 mg of pred per day. Since then I've had no flares and at present I'm okay at 10 mg per day.

[PMRpro Ambassador in reply to Marijo1951]

But that could merely be a reflection that by the time you started the mtx the activity of the underlying cause of the GCA was waning and you would have been able to taper more easily anyway. I'm not saying it isn't due to the mtx - I always say it may work or it may not.

[Marijo1951 in reply to PMRpro]

But I feel now that it could well have been mtx and I shouldn't take the risk of discontinuing it. I have my monthly blood test and no problems have emerged so far.

[PMRpro Ambassador in reply to Marijo1951]

That's fine then - and I never deny it helps some people. If you can take it and have no problems that is fine. But no-one should feel pressured to try it if they don't want to nor stay on it if they are unhappy. There are other longer term aspects as well but that is another matter.

[Marijo1951 in reply to PMRpro]

I agree. I refuse to take bisphosphonates as I instinctively feel they are wrong for me. Of course, this kind of woolly thinking doesn't impress my rheumy. I would have stopped the mtx if I'd found it in any way unhelpful.

[PMRpro Ambassador]

The first trial he mentions seems a bit strange - they tapered by using an alternate day approach so that the patients went from 60mg per day to 60mg on alternate days. Nothing wrong with that you may feel - except they had a very high rate of late visual loss in this cohort. Visual loss in the first few weeks after diagnosis is not unusual unfortunately but later loss is very rare.

But the bottom line is: if might help, it might not.