Getting off low dose prednisone and MTX

[Missmymuscles]

I have heard some of you mention it is hard to get off prednisone while on MTX. Why? I am on 2 1/2 mg of pred and 25 of mtx. Should I try to get off the mtx first? Feeling good and I don’t want to mess this up but I’d love to be off all of this.

[SnazzyD]

I don’t think it’s due to the combination per say but more due to the fact that some people struggle to get their adrenal function back at low Pred doses. Methotrexate merely doesn’t help with this aspect rather than making it harder. If your adrenal glands aren’t working at full capacity yet you would feel really tired and generally flat and if they are totally overwhelmed there are other symptoms too. At this point you need to slow down your Pred reduction rate. If you feel fine you are likely ok in this regard but it can take you by surprise especially if you have a sudden or sustained stressor on the body.

[piglette]

People normally come off pred first and then the MTX. Talk to your doctor.

[PMRCanada in reply to piglette]

Agreed. That was the plan my rheumy and I made.

[PMRpro Ambassador]

Methotrexate doesn't work for everyone to get off pred - if it doesn't work, it won't make getting the pred dose down any easier.

I would say see if you can get off the pred first. Then, after some months on MTX without any relapse you can try slowly reducing the MTX. There are no guarantees - the only way to find out if you can, is to try, But 2.5mg pred is a reasonable dose to manage low level PMR, you are by no means out of the woods yet.

[Missmymuscles in reply to PMRpro]

Thanks pmrpro. I was stuck at 10 around May. The methotrexate has enabled me to get down to 2 1/2 but I flared a few months ago when I went lower than 2. Staying at the 2 1/2 for now.

[PMRpro Ambassador in reply to Missmymuscles]

That's what I meant - even with the MTX you may not get off pred entirely - but it is very likely that if you stop the MTX you will need more pred again.

[dancersize2]

I got off the pred in Jan after four and a half years, and three of that with MTX added. Rheumy said stay on MTX but I chose to reduce to 15mg weekly then 10mg, Had a respiratory infection in October so stopped the MTX. Pain returned and blood test showed elevated levels so started on 10mg MTX and a short burst of pred. Three weeks of juggling later I finally had a phone call from my rheumy in answer to an email I'd sent about it all. She said the blood test wasn't all that high (different number to what GP had told me) and her advice was to go back up to 20mg weekly of MTX. I'm trying panadol and iboprofen with the weekly10mg MTX and hope it all settles again. Next rheumy visit is early Feb so I'll see where I'm at by then. I'd hoped to be off it all by the end of this year. Doesn't seem likely now. It is especially disappointing when these odd aches suddenly appear. At least I'm still able to dance.

[Carrie27]

I found it impossible though I know for some it works. Since I came off methotrexate some reduction in dosage of steroids has been possible.

[Missmymuscles in reply to Carrie27]

Do you mean you got off the methotrexate first?

[Carrie27]

Yes.

[Ozziedays]

hello, I’ve just come across your post. I started on MTX just over a year ago after my second flare at around 5mg pred. I got to zero pred last month and my rheumatologist is recommending I stay on MTX for a further 18 months.