Update from 2 weeks ago

[Swiftandbold1]

Not sure if this is the place to update after a gap. Speaking to rheumy later as down from 20mg to 15mg over past week and def not working. Symptoms back plus nausea etc so prob also due to pred reduction. Their plan is methotrexate add in which is I don't have an issue with but wonder if we've been trying long enough to sort pred dose. 30mg was lovely! Also random thought - does anyone ever actually get stuck on higher doses as they just cannot reduce? Thoughts please.

[DorsetLady PMRGCAuk volunteer]

Not surprised you’re not so good...20mg to 15mg is too big a jump! Some struggle with 20 to 17.5.

General advice is not to reduce more than 10% of existing dose - so at 20mg - 2mg, whereas you’ve reduced 25% - most bodies cannot manage that.

Rarely people get stuck, but not often if their reduction is managed properly...as for MTX - never been on it so cannot comment...but what I would say is your Rheumy hasn’t given the Pred a proper chance to work...you’ve been up and down like the proverbial Jack in the box - and that’s not controlling your GCA as it should be. So no...not long enough on the Pred!

Others will be along shortly to advise on MTX.

By the way, could you update your profile, so we can easily access your situation, rather than have to go back through old posts - thanks.

[Yellowbluebell]

Your post is in the right place. You havnt been on pred that long and it seems a bit premature to be bringing Methotrexate into the picture at this stage. I personally would want to try pred on its own for longer but its a personal preference.

Mrsnails willl no doubt be along in a bit to give you advice on using Methotrexate as she is using it for the 2nd time and has lots of info available. Good luck whichever way you decide to go. YBB

[SnazzyD]

Hello. To save hurting my head, can you tell us how long it is since you started on 40mg and what the dose periods were? From a quick look, it seems you haven’t been on it long enough to satisfy most protocols, so a long way from worrying about getting stuck on high dose or it not working. It may be you are feeling that you are getting stuck simply because you’ve not been on 30 or 40 for long enough and the autoimmune process is still too active.

[piglette]

I was told to reduce from 20mg to 15mg and it was a disaster. My rheumie only gave me 5mg tablets. A friend started on Methotrexate right at the beginning and reduced to zero in a couple of years with no problem. You really cannot tell. Some people have problems and others don’t.

[PMRpro Ambassador]

You can't drop 25% of the current dose and expect it to work! Pred for PMR is a long term and slow taper, not used as they use pred for acute conditions or to settle a flare of RA.

Methotrexate MIGHT help - but then again, there are no guarantees and it is adding another layer of potential adverse effects.