Update on ? Am I having a Flare

[mtrafter]

I wrote previously on my concerns re experiencing palpitations , dizziness, low ish B/P as well as increased stiffness at 6mg pred during a viral infection. Thanks to your advice I increased to 8mg. Saw my Gp who put it all down to my viral infection and not having enough prednisilone on board advised to increase to 10mg, ordered bloods and had an ECG which was essentially normal.

Saw my Rheumatologist yesterday, my bloods were raised, he agreed it was most likely my infection that has thrown my body out of whack. To stay on 10mg for 2 wks to get on top of the inflammation, reduce to 7.5 and then 5mg ! Well I might just wait and see I probably will need to go slower to 5mg as I have never got to 5 yet in 2 yrs. He then dropped a bombshell and said I may never get off Pred!!!He felt my adrenals were not responding or waking up.

He also mentioned the dreaded Metheltrexate again if I cant get to 5mg by my next appt in 6mths.

I also will ask for the test to check adrenal function at this review.

Also have a referral to a cardiologist for my continuing intermittent palpitations.

Also have 'sick day' treatment plan for any further infections - Double dose of pred. I will now be better prepared.

Many thanks for all your support and suggestions.

[PMRpro Ambassador]

Excuse me - what is he thinking about?

He tells you you will require pred because your adrenal function is compromised - and that means you will need a low dose (usually about 5mg) ongoing - and THEN brings methotrexate into the equation. It will do nothing for the adrenal function, you will still need pred for that (or to switch to hydrocortisone but that isn't essential if you are well adjusted on pred) so since you are already at a physiological dose (7.5mg or less) why on earth does he want to add in the potential side effects of another drug? There is a very simple word in the the English language: NO. Thank you ...

[mtrafter in reply to PMRpro]

That's exactly what I said! And not for the first time.

[SheffieldJane]

I am surprised that your doctor would suggest Methotrexate when it has liver and kidney damage in its side effects and you have a liver disease. Only a Synacthen Test for your Adrenal function will confirm a deficiency? It seems early days to worry you about being on Pred for life. What function is the Methotrexate supposed to perform? Your progress on Pred seems fairly average to me. I am puzzled by the advice you are getting but do not understand the full implications of your liver condition of course.

PMR 3 yrs 4 months, Pred. 5 mgs. Diagnosed Adrenal deficiency - expected to recover ( 95% chance).

[mtrafter in reply to SheffieldJane]

I refused Metheltrexate 10mths ago, went back to Liver specialist and had Liver biopsy to see at what state my liver was in (pior to considering adding meth )which was fine. Since then over the last 3mths my LFT tests are in abnormal range and unstable where previously for 10 yrs have be very stable and unremarkable. Not sure if all PMR meds have made a difference I am seeing Liver specialist for review in 2 wks.

[SheffieldJane in reply to mtrafter]

Good luck with your review. I have a lot of respect for the thoroughness of Australian medicine, having experienced it during my many trips to visit family over the years.