Azathioprine and how it works

[Angel_doll]

My rheumy wants to put me on azathioprine at the same time as reducing my pred by 1mg each month. I have some questions, and he is one of those people who ask, but don’t answer, so I’m looking for some help from you lovely people. First, how does azathioprine work to get the pred reduced? As I understand it, pred is the only drug that helps PMR, so if I’m on my minimum dose, and reducing it any further exacerbates my symptoms, will the azathioprine actually help? Second, should I be on a stable pred dose before embarking on azathioprine? Currently I am on 8mg pred, about 14 months since diagnosis. I had been down to 7mg, using the DSNS tapering, and each time I stepped down .5mg I experienced mildly worsening symptoms, then a flare after my fourth covid jab. GP said return to 8, I returned to 10, rheumy said back to 8 after 2 weeks. I’ve been back on 8 for 9 days now, and am still having a lot of hip and leg pain/weakness. Any words of advice/encouragement will be much appreciated! I shall try and get an appointment with my GP next week to see what their thoughts are.

[PMRpro Ambassador]

It is thought to alter the metabolism of the pred in some way so you get more bang for your buck out of a given oral dose. Very few people are put on AZA for that - there are few if any studies in PMR but it does work as a steroid parer in asthma. Methotrexate and leflunomide are the more usual and there are publications with varying results in the medical literature about them. Some people respond to DMARDs (as these drugs are called as they modify the disease process in RA), others don't. Possibly some forms of PMR are more inflammatory arthritis than others.

If you look at the Related Posts (at the side on my laptop, maybe at the bottom of a phone screen?) there are already several on the topic.

[piglette]

Perhaps you should have increased the dose by 5mg for a week or so to really hit the PMR on the head. DMARDs work for some people and not others in the case of PMR.