Leflunomide or methotrexate : I’ll be seeing my... - PMRGCAuk

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Leflunomide or methotrexate

Lochy profile image
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I’ll be seeing my rheumatologist in a couple of weeks and as usual like to go prepared.

I’ve been on hydroxychloroquine since end of November 2018 and then leflunomide was added mid February 2019. These were added to my prednisolone as I was suffering from painful and swollen knees. Steroid injections and fluid drained on knees which definitely helped. Although methotrexate was actively discussed I resisted because of my typically elevated liver function tests. (My LFTs have been raised for quite a number of years and the onset of PMR put them through the roof. Liver biopsy before I started prednisolone in March 2016 reassured all that my liver was in good condition)

So my question is - is leflunomide a weaker drug than methotrexate or do they just metabolise differently? I am unsure whether either hydroxychloroquine or leflunomide are having an impact on my knees as they still swell and feel sore but not just as much as before! This could also be attributed to the steroid injections in mid February wearing off. So part of me is thinking do I just stop them and continue the dead slow taper. I’m currently on 9mg.

If I vocalise my thoughts I’m concerned they’ll persuade me to start methotrexate so I want to go along with an informed opinion and I knew I’d likely get one from my fellow PMR sufferers..

Thanks

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Lochy
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They are different. They are both touted by many doctors as a means of reducing the dose of pred. A trial using leflunomide found 21 out of 23 subjects went into remission successfully. Hydroxychloroquine doesn't get a mention in the 2015 Recommendations except as there having been one poorly powered study which found no benefit. Leflunomide gets NO mention (Recommendation 7). On the other hand - I have a friend who did find a rapid and noticeable improvement in how she felt on leflunomide, considerably greater than with methotrexate. The downside was she developed neuropathy and had to stop with a rapid return of PMR symptoms. Now she is trying a half dose.

rheumatology.org/Portals/0/...

With any of them there is no guarantee - even Actemra/tocilizumab isn't 100% successful in removing the need for pred. All you can do is try and see if the benefits outweight the adverse effects for you. And at the end of the day - the question remains unanswered as to whether maybe there may be multiple versions of PMR with differing underlying causes which require different approaches.

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