For some reason doctors seem to want to get you off of Prednisone and often times put you on a dose of Methotrexate which was my case. Actually he wanted me on both and then when on the Methotrexate felt that I could immediately taper off of the Prednisone. So my second month on Prednisone he added the Methotrexate. I am not the best person to ask where I am sure that it works well for a lot of people it did not for me. I did not feel "well" when I was on it and actually some of my hair came out not a lot but enough to be disturbing. My brother-in-law is a doctor of Pharmacology and his speciality is cancer drugs and helping doctors regarding medications given. He was surprised to learn that I had been put on Methotrexate and advised me to get off of it. He said he would only use it for cancer patients due to the side effects. He felt that I was better off just staying on Prednisone and eventually start to taper down which I have. I started in the Summer of 2021 with 10mg and recently have gotten down to 2.5mg. of Prednisone and so far doing well.
Methotrexate : For some reason doctors seem to want... - PMRGCAuk
Methotrexate
To be fair, the doses used for rheumatology purposes are far far lower. My husband said much the same though - he had a form of PTSD due to it being used for him in cancer therapy but it was a massive doses.
I am on methotrexate because am unable to take steriods. Feel lousy the day after but otherwise no sideaffecrts and really helped.
Good morning, sorry to learn about your situation. However, the doses of Mtx used for steroid sparing are much lower at ca. 20-25 mg than for cancer treatments. I inject 20mg weekly and am on 10 mg pred with very limited side effects from the mtx. It varies though between individuals, and it may not have suited you. Good luck
Last summer I had a follow up with a new rheumy who said that after nearly 5 years on Pred I should be off it and he wanted to put me onto MTX even though I told him I was PMR symptom free and was now tapering to get off 4mg Pred. We had a robust conversation about side effects of MTX and Pred, osteoporosis (he actually told me DEXA scans were pointless!), steroid tapering and acquired adrenal insufficiency. It seems to me that the medics are all obsessed with the devil drug (Pred) and don't think that there's any problem with MTX. They have a poor understanding of what it's actually like to get off Pred even if MTX would be an appropriate option. Listen to your brother-in-law!
Me: Diag Nov 2017 Current 2.5mg. Retired Pharmacist 64 years.
Surely at 4 mg you’re best staying on Pred and not adding in anything else
Am intrigued about dexa scans being pointless wonder why??
They don't give absolute figures and are very dependent on the angle the rays strike the tissues. But actually the whole thing is a bit subjective - the borderlines between normal/osteopenia/osteoporosis were set quite arbitrarily. Low bone density doesn't mean weak just as high bone density doesn't mean strong - most people who have a bone fracture have "normal" bone density.
There was a very telling study on MTX in RA. Rheumies almost all said it was a great drug and patients had no problems with it. However, patients experienced it very differently. with about a third having to stop because of adverse effects and about a third because it simply didn't work. So only 1 in 3 patients had a positive view of a drug they got good results from and could tolerate. And it is the first line drug of choice for RA - it's reputation in PMR remains mixed.
In the UK, Methotrexate is used all the time for rheumatoid arthritis and PMR. It’s the go to drug.
It is not used all the time for PMR. Anywhere. It is the first line starting drug for most rheumatoid arthritis patients but the go-to drug for PMR is a corticosteroid. MTX will almost never be used first line for PMR and only if there are serious contraindications for steroids, There is little enough evidence that MTX works as a steroid-sparer alongside pred, to my knowledge there is none at all that it works on its own. There is always the risk that the PMR is an early sign of GCA and if the patient has GCA it would be downright negligent and unethical to offer the patient anything other than steroids which are known to protect them against the risk of loss of vision - nothing else is proven to do so.
Thank you for raising this and PMR Pro for her comments. I am currently being pushed towards Methotrexate after my PET Scan as I don't seem to be able to drop below 10mg but have been warned that my immunity will drop even more which does not bode well with the current outbreak of colds, Covid and flu. My concern is that if I don't go this way then they will drop me as a patient. I have already been told that because I refuse biophosphonates then they won't give me a Dexa scan which I am due for now (2 years). As if this dangerous drug is the only answer for bone health!!
That's a bit cock-eyed! The usual excuse is you don't NEED a dexascan if you are on bisphosphonates!
I take Prednisolone and Methotrexate and have just had a Dexa scan.
So not impossible!! Thanks R.
No not impossible Alchemy, in fact I had the previous one 2years ago. 🙂
Methotrexate can allow for less Prednisone to be used. Methotrexate is once a week.
My PCP refuses to give me any. Claims it is a dangerous drug, but I think prednisone is more dangerous. I am referred to a rheumatologist, for June 21, 2023. Like 4 months away!!! I hope he gives me some methotrexate. I am also on insulin and taking 20mg prednisone I have to double my insulin to 40 units in the am, otherwise my glucose spikes over 400.
whatispolymyalgia.com/treat....
MTX MAY allow for less pred to be taken. It works for a small cohort of patients but probably DOESN'T work for more. And it can be a lot more unpleasant to take than pred - it was for me.
I am interested in it as I take insulin, and prednisone is very bad for my glucose as I am diabetic and I have high blood pressure which has been hard to control.
Who should not take Prednisone (Pak) Oral?
The following conditions are contraindicated with this drug. Check with your physician if you have any of the following Conditions:
active, untreated tuberculosis
inactive tuberculosis
herpes simplex infection of the eye
a herpes simplex infection
an infection due to a fungus
intestinal infection caused by the roundworm Strongyloides
a condition with low thyroid hormone levels
diabetes
insufficiency of the hypothalamus and pituitary gland
high cholesterol
low amount of potassium in the blood
a reduction in the body's resistance to infection
psychotic disorder
a disease with shrinking and weaker muscles called myopathy
increased pressure in the eye
wide-angle glaucoma
clouding of the lens of the eye called cataracts
high blood pressure
chronic heart failure
an ulcer from too much stomach acid
and more, that list runs on aways.
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