On Pred and going onto Methotrexate - help needed

[Theziggy]

HI, I am on 15 mg Prednisolone and my Rhuemy finally agreed to diagnose me with Palindromic Rheumatism )after 16 months on steroids) so he is putting me on Methotrexate which I will be starting tomorrow, so, should I also continue with the steroids - I know I will have to start a taper - just a bit confused at the moment

Thanks in advance

[Marijo1951]

Yes, you MUST continue with the pred. It's the pred that treats your condition. The methotrexate is to help you reduce your pred dosage, not to replace it. I'm currently on 7 mg pred per day with 15 mg methotrexate every Friday.

[Theziggy in reply to Marijo1951]

Thank you Hidden - thought you were taking it easy!!!!

[Hidden in reply to Theziggy]

I am Ziggy, just keeping an eye on the Methotrexate Crowd 😉

You will most definitely have to taper the Pred; you can ring the Rheumatology Team to ask them about the Plan for Tapering. But for now until you’ve started the MXT & heard from the Team remain where you are. I managed to came down 1mg per month until l got to 9mg then came down by 0.5mg using one of the slow tapering methods.

Good Luck 🍀

MrsN

[PMRpro Ambassador in reply to Marijo1951]

Ziggy is to use mtx for palindromic rheumatism, a precursor to inflammatory arthritis. Different thing.

[Hidden]

Hi Ziggy

Even though you have a change of diagnosis & are starting Methotrexate you will have to taper the Pred, how long have you been on it?

I would have thought the Consultant would have suggested a Tapering Schedule?

I’ll have a read through your last couple of posts.

Kind Regards

MrsN

[Theziggy in reply to Hidden]

I have been on Pred for over a year, Rheumy finally diagnosed me me with Palindomic Rheumatism this month and prescribed Methotrexate. No tapering plan suggested.

[jinasc]

You must not stop pred abruptly you could run into a an adrenal crisis. So make no decision till you have talked to your Consultant or GP. Take both.

Have you been told that the PMR was the wrong diagnosis or do you know have both?

Metho can be the gold standard treatment for some arthritis conditions.

A fellow suffered was diagnosed with Late Onset RA and was put on Metho, not as a steroid sparing agent, but because of the LORA, about 4 weeks later as it happened she was put on a slow tapering of the pred and eventually was able to stop pred. She took the metho on a Friday as she was able to do less over the weekend. Remember you also need Folic Acid as it can and does cause hair loss.

[Theziggy in reply to jinasc]

My GP read out my Rheumy's letter and it said Palindromic Rheumatism/RA

[jinasc in reply to Theziggy]

I don't know the difference between one sort and another, I am not a Medic............talk to your medics today.

[Theziggy in reply to jinasc]

Thanks jinasc Can't ever contact my Rheumy - 4 year waiting list here to see one, my (very good) GP may set me straight.

[DorsetLady PMRGCAuk volunteer in reply to Theziggy]

4 years??

[Theziggy in reply to DorsetLady]

Yip - Northern Ireland

[DorsetLady PMRGCAuk volunteer in reply to Theziggy]

Blimey - that’s atrocious. Poor you- good job you’ve got a decent GP.

[Theziggy in reply to DorsetLady]

Absolutely, he is a gem

[PMRpro Ambassador]

For inflammatory arthritis the mtx is likely to take a few months to build up its effect so many doctors use pred to provide relief at the start. I would think that you will slowly see the flares being less frequent or less severe and at that point you may be able to think about trying to taper the pred although maybe it would be best to wait until they are well under control.

I wouldn't worry about it for the moment - not least because you have to find the DMARD that works and it is possible it may not be mtx but it is the first line approach worldwide. Most rheumies allow up to 6 months for the DMARD to show an effect - another bit of patience.

[Theziggy]

Yip another bit of patience, I had been flare free for months and thought I was cured and then had a fortnight of flares which roved around my body with impunity. Will start the Mtx tomorrow - 1st August.