Methotrexate

[Pym1]

A couple of years back I saw some posts about the above as a proposed non-steroid treatment for PMR.

Two people I have come across recently who also had PMR swear by it and ask why on earth it’s not been suggested to me.

Any comments please, you lovely people?

Pym1

[PMRpro Ambassador]

Are they on it as a single therapy? Or in the hope of reducing the pred dosage?

Look at the list of the Related posts - there are a load about methotrexate. MrsNails has written a fair bit about it.

It may work for some people but you have to try it to find out. A lot of patients find the side effects of mtx unnacceptable - within a month I was so fatigued until lunchtime of the day I was due the next dose that I couldn't function. That on top of hair falling out in chunks. constant hunger and weight gain, and feeling achier than I did with unmanaged PMR I said no thank you!

There seem to be a few different versions of PMR and it is possible that it can be a precursor of a couple of forms of inflammatory arthritis. If you have one of those versions then it will probably help you get to a lower dose of pred but there are no guarantees.

It is possibly worth a try but unless it helps and you have no adverse effects I really can't see why anyone would want to add another pretty hefty drug on top of pred. An immunologist and I discussed it at a meeting a few years ago - and they are concerned about the long term effects of the extra suppression of the immune system .

[Pym1 in reply to PMRpro]

This is very helpful. I also asked my brother in law who’s a retired orthopaedic surgeon. He knows my medical history well. A man not normally known for short responses, to this question he replied ‘no, no, no. Not suitable for you’. As others have said, it obviously depends on individual circumstances.

Again, many thanks for your response.

Pym1

[MrsNails]

I’ve written War n Peace on MTX so look at my profile & you’ll see various posts.

I can remember being at a PMR/GCA Roadshow about 5years ago & they were discussing it then as a first line treatment but l’ve heard nothing about it since....

What dose of Pred are you on? How long have you had PMR?

Kind Regards

MrsN

[Roy46 in reply to MrsNails]

At a recent telephone appt with rheume, first in 2 years, she was more intent on getting me off of pred than listening to my story of aches and pains.

Booked blood test that included elements I've not heard of: ANA Screen, TMPT, Anti-CCP, ZEP serum electrophoresis and others. Results awaited. She's given me the option of MTX or Azathioprine. MTX I've heard of from this forum. I agree PMRpro, why add another layer of drugs onto pred. But I've not come across Azathioprine. Any views?

I'm GCA/PMR and have been for 8 years. Currently bobbing along around the 8mg marker, with difficulty getting below that number.

[PMRpro Ambassador in reply to Roy46]

ncbi.nlm.nih.gov/pmc/articl...

is a link to the only study I know of that was presumably the one considered when drawing up the guidelines for managing PMR - they described it as poorly powered, it is certainly fairly small and only ran for a year. They don't recommend it.

The results are hardly overwhelming - there is a very high withdrawal rate due to adverse effects and they found it took the year to see a difference in dose. And they don't know what happened later.

[Roy46 in reply to PMRpro]

Thanks PMRpro. Good and useful background to deter my rheume from prescribing either and both of the drugs.

[PMRpro Ambassador in reply to Roy46]

Aza seems to work as a steroid sparer in other things, like asthma I think. But PMR isn't asthma ...

[Roy46 in reply to PMRpro]

I'll stick with reducing ever so slowly without recourse to even more drugs!

[Pym1 in reply to MrsNails]

Thanks. Please also see my response to PMRpro. I’ve had it for 4 years. Have on occasion got to 3.5 but couldn’t cope so have gone up to 5 a day and whilst it niggles and hangs about it’s usually bearable. Just have to ride with it, I guess.