Methotrexate

[Macadoo]

Has anyone taken methotrexate to reduce or become completely off prednisone and then stop taking methotrexate for PMR? Or did you need to stay on MTX to prevent future flare ups?

[PMRpro Ambassador]

I think I have heard of a few who got off pred - but it isn't a common occurrence as far as I know. They get to a lower dose of pred quite often if they can tolerate the adverse effects. Prof Sarah Mackie admits - it works brilliantly for some patients but by no means all. You have to try to find out which you are. I think there is maybe one version of PMR it works for - or it is misdiagnosed inflammatory arthritis.

[Macadoo in reply to PMRpro]

Thank you PMRpro!

[Yorksman in reply to PMRpro]

I'm trying to get well informed about Methotrexate pending my next rheumy appointment and your interesting comment about there being 'one version of PMR it works for'. Do you know how many versions there are and which version does it work for? Can I find out which version I have? Also what is Inflammatory Arthritis and how does it differ from PMR?

[PMRpro Ambassador in reply to Yorksman]

It is a very new idea amongst medics really - but it is obvious there are various versions, it isn't a simple homogenous disorder that has a fixed presentation and duration - pretty much every patient is different and doctors need to adjust their approach depending on the particular patient.Inflammatory arthritis is joints, PMR isn't really joints, RA is an inflammatory arthritis but there are quite a few different version of arthritis too.

hss.edu/conditions_living-w...

healthline.com/health/infla...

[Yorksman in reply to PMRpro]

Thanks, learning all the time.

[MrsNails]

Hi - When l first went on MTX in 2014 - l reduced from 18mg to 7.5mg in monthly drops from 18mg to 9mg & then went down by 0.5mg drops to 7.5mg

However, my world was turned on it’s axis with a diagnosis of Breast Cancer so that kind of screwed things up, to say the least.

I’m currently on 10mg Pred & 25mg MTX weekly by injection - this time around it’s not so easy to drop as there have been complicating factors……

But l’d say it’s worth a shot - Wishing you all the best MrsN 🍀

[Macadoo in reply to MrsNails]

Thank you!

[discoballs in reply to MrsNails]

Thank you MrsNails xxx My GP mentioned MTX today. He is really a superb man and lovely Doctor. This gives me hope....

[MrsNails in reply to discoballs]

It’s definitely worth a shot - l’ve written a fair bit up on it in FAQ’s

The trick is choosing a day that suits but the important factor is it’s usually the following day that has the impact.

Drink lots of water, take your Folic Acid (on non MTX Days) make friends with the Rheumy Nurses as they can be really helpful.

It has no impact on me these days but 10mg Pred is the lowest l can get 🤦🏻 I went back to 9mg but its evident its not enough…..

Maybe time for a review, l think 🤔

Let us know if/when you start it.

Good Luck

Angela 🍀

[discoballs in reply to MrsNails]

Cheers Angela xxxx

[Bluesew]

I was reluctantly persuaded to take 10 mg methotrexate last September when I was stuck at 15mg prednisolone. (I have PMR and GCA). I have managed to steadily reduce to 5mg.

[Macadoo in reply to Bluesew]

Are you experiencing MTX side effects?

[Bluesew in reply to Macadoo]

Not too bad. I do feel particularly tired the following day and I make sure I drink plenty of water and rest. My hair is thinning but I have never experienced any sickness and diarrhoea. I have my bloods checked regularly and my liver function is fine.

[Blackcatlover]

I’m one of the ones that Methotrexate was not a good choice. I took 20mg once a week and was sick as a dog for three days after. I would have four okay days and then was sick again after my next dose. It never allowed me to get below 15mg of prednisone. I took it by mouth for four months and then switched to Actemra. I’m now down to 4mg of prednisone and injecting Actemra once a month and doing well. Have just had surgery so I’m happy to stay on this schedule. In a couple of months I may try to decrease prednisone again. Good luck. Hope you are one of the ones that Methotrexate works for.

[Macadoo in reply to Blackcatlover]

Do you have side effects from Actemra?

[Blackcatlover in reply to Macadoo]

Not really. I’m tired( or more tired) the day I inject and have a large red area at the injection site but find I feel so much better overall because my prednisone is down to 4mg. I do bloodwork every three months and so far so good. With the Methotrexate my liver function was going down after three months.