Curious

[YuliK]

Rheumatologist recommended methotrexate when I was on Prednisone 15mg per day ...to help lower the prednisone quickly.

Would we still do the very slow reduction of prednisone ?

I just realized something else. say that the methotrexate helps to stop pains, ( but we know that it doesn't cure pmr ) how can we know if the Prednisone has cleared up the PMR completely. ?

How do we know if our adrenals are working normally.

We know that not all the blood tests give a correct reading as to our situation. If eventually we wean off the methotrexate, will our pmr return.

Does anyone have the answers...?

YuliK 76

Started 25 gram prednisone

Now 7gm

[Hidden]

I can answer your first question - l was started on Methotrexate when I was on 18mg of Pred with a Plan to reduce by 1mg per month, l still used a dead slow taper adapted to reduce every four weeks & l successfully went from 18mg to 7.5mg - the taper was changed to 0.5mg per month from 9mg -7.5mg which is when l stopped it for Surgery.

I was off it for close on 15 months when l went back on it to reduce from 7.5mg - 5mg

Unfortunately it had to be stopped last August due to raised Liver Levels, l am now back up at 10mg Pred.

Jane will probably reply the Adrenal Glands I’m sure but you are at 7mg which is when we hope the Adrenals will wake up, however they appear to prefer to sleep in a lot of cases!

MrsN

[YuliK in reply to Hidden]

Thanks Mrs Nails

Thanks so much for your intel.

Did you continue to take methotrexate during your surgery period, or did they stop both pred and methotrexate. ?

Hope you are feeling better after your surgery.

I have a fatty liver. ( not to mention my fatty derrière 😀). and I'm worried about all this medication.

I'm coping nicely with Prednisone so in the meanwhile I'll just stick to that regime.

Your help greatly appreciated. ❤️

YuliK 76

25mg pred

Now 7 mg

[Hidden in reply to YuliK]

Hi Yulik

The MXT has to be stopped for Surgery but not the Pred & l had Hydrocortisone Cover in Theatre & Over Night, followed by an increase in Pred on 2.5mg for two weeks as per my Rheumatologist.

Sadly, it was Breast Cancer & l had to have Chemotherapy following my Mastectomy so MXT was contraindicated.

I’m 3&half years now Post Surgery/Chemo & hanging in there, l had Triple Negative Breast Cancer so it’s a bit of a Bad Boy to treat but so far, so good 🙏🏼

I too have a fatty liver 😉 oh the joys of getting older.

I hope you do well to continue on your reduction, have you considered going down in 0.5mgs now as it’s less stress on your system.

Best Wishes 💐

MrsN

[YuliK in reply to Hidden]

Yes I will go down by halves. ❤️

[5lupins in reply to Hidden]

Wow , from what I have read in previous posts you are doing good. Your experiences should make you a good moderaters. Thank you Jen x

[stellafmdm in reply to Hidden]

Me too, I think halves will suit me better!

[Hidden in reply to stellafmdm]

My lovely Consultant always recommended drops by 0.5mg from 10mg & alternate days if necessary, she really understood the difficulties of reducing Pred. x

[SheffieldJane]

This runs through my head too. It doesn’t fit yet does it? More research on this topic is needed. Rheumatologist’s seem convinced it is beneficial.

[PMRpro Ambassador]

Steroids do not "clear up the PMR" - all they do is mop up the inflammation which is created every day, in the early morning. First you use a higher dose to clear out existing inflammation and then you reduce slowly to find the lowest dose that manages that daily release as well as the starting dose did.

The mtx won't reduce the pain of PMR and mtx will not necessarily allow anyone to reduce the steroids more quickly - in some people they do something that changes the efficacy of the pred and they get more effect from a given dose. In others they do seem to help reduce the risk of flares associated with reducing the dose. It suppresses the immune system more than pred alone so you do risk having more or worse infections - and often have to stop taking mtx when you do have infections, especially if you need antibiotics.

mtx can cause fatty liver disease - so if you already have that anyway, I would be refusing to even try it! Has your rheumy not read your notes?

[YuliK in reply to PMRpro]

Thanks PMRpro.

I seem to be bombarding you all with so many questions. 😢 The rheumatologist would have to sit two hours to read all my ailments. But you are right, no way I will take methotrexate or similar with my fatty liver. I think you mentioned it once on the 'other'

forum....it was before I was offered methotrexate...but it did ring a 🔔...you are so knowledgeable and your knowledge brings such a lot of comfort and peace of mind to us ...thank you.

Regarding my rheumatologist, yes it was a huge oversight on her part not to ask if I have a fatty liver...I'm no skinny Minnie.

[PMRpro Ambassador in reply to YuliK]

Not sure being cuddly is always a prerequisite for fatty liver!!

As for questions like that - that's why we are here and the purpose of the forum.

[Hidden in reply to YuliK]

Unfortunately Pred is implicated in fatty liver disease as well.

livertox.nih.gov/Phenotypes...

[Patience47 in reply to Hidden]

Thanks for the info.

[YuliK in reply to Hidden]

Thank you for the link Tynemouth. It makes very interesting reading. Lots of information there too. 👌

[Pollyanna16]

Thank you for bringing this up. My Rheumy has been keen to put me on mtx for over a year to help reduce Pred. Got myself down to 2.5 & now on hydrocortisone in preparation for a blood test for Adrenal function & psoriatic arthritis, as she thinks I have that rather than PMR now. I am not convinced. Hate the idea of mtx. Hey ho. Good question how do we know when PMR has gone after 7 years I can’t remember what normal feels like 🙄

[stellafmdm in reply to Pollyanna16]

My Rheumy wants to put me on MTX but I'm not so sure given the trouble I've had with my liver, and gall bladder (when it was still in!).

[YuliK in reply to stellafmdm]

Not a good idea for you at all. Does your doctor know your liver and gall bladder past history.

See the link that Tynemouth kindly posted on this thread. A few posts above yours.

[stellafmdm in reply to YuliK]

He should, but has probably forgotten! I'll remind him if the MTX word comes up!

[YuliK in reply to stellafmdm]

Stella I'm convinced that some of the doctors are not aware of the mtx limitations.

I wouldn't have known about fatty liver limitations if it hadn't been for this forum. Bit scary when we have to do the research.

Thank goodness we have first class advice here. 👍