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