Preds and Sparing drugs

[Blomps]

I have had a 9 month rollercoaster with PMR. Now tapering of for a second time but this time with the aid of Methotrexate. Now down to 10mg daily Prednisolone with 15mg methotrexate once a week. Dropping 2.5mg Preds every 3 weeks. So far touch wood all is well. I was reluctant at first to add another pill to regime but now pleased I took the advice given. Good luck Blomps

[SnazzyD]

I hope it continues to be smooth. The sparer doesn’t help the adrenals though, so you may need to slow down if they don’t fire up at the same speed you’re reducing. Below 10mg is when it starts to show, particularly from about 7mg, depending on the person.

[Marijo1951]

I had two bad flares of GCA symptoms when trying to reduce pred to 25 mg per day. The second time I was prescribed methotrexate (10 mg per week at first, 15 mg after a couple of months) and I've had no flares since. I'm monitored by monthly blood tests and so far I've had no serious side effects from the MTX. I must say however that I've reduced my pred dosage very slowly since I first started the MTX. I'm now on 7 mg after alternating 8 mg and 7 mg for several weeks.

[Blearyeyed in reply to Marijo1951]

Good experience advice , so glad you are doing well with it.

Perhaps going slower as you have done may be something Blomps might want to keep in mind to get the same sort of success without the side effects just like you have done.

People do tend to forget ( especially Doctors!) that taking steroid sparers isn't just meant to make tapering faster or get people off Pred at the speed of light .

It's meant to make getting off Pred easier , less painful and more manageable by helping control the affects of inflammation , making getting to lower doses more successful with less rebound flares.

Substituting one form of pain control for another.

Sometimes MTX is necessary for use even if tapering is done at the slower speeds.

[PMRpro Ambassador]

In PMR you do not start taking pred and then simply "taper off" - PMR is a chronic disorder where the median duration of pred management of the symptoms has been found to be 5.9 YEARS, not months, If you tried to get off pred like that, no wonder you ended up on a rollercoaster. You aren't reducing relentlessly to zero pred, you are looking for the lowest dose that manages the inflammation as well as the starting dose did. Once you get to 10mg you should slow the taper, at least in terms of steps down. Dropping in large steps means you can easily miss the right dose: 10mg may be plenty, 8mg may have been enough, but 7.5mg isn't and it all comes back.

I do hope it continues to work for you but it may not just be the methotrexate, it could be the underlying disorder has reached a different and less active stage. Do be aware of any returning symptoms and be ready to stop reducing or even add a 1mg and take a break at reducing. It doesn't mean you won;t get lower - just not yet.