15mg MTX on holiday and in pain

[Dancesaver]

Good afternoon my pmr diagnoses from July ‘22 was changed to RA in Dec’22 I’ve been taking 15mg MTX since February while reducing from 10mg pred to zero. (Starting on 20mg) I’m currently on holiday in Crete and had hoped that rest, sunshine would ease my pains but unfortunately it hasn’t, possibly slightly worse I’ve discovered new areas of pain, sitting bones and thighs, wrists are particularly painful . I have been g/f for a few weeks

so I’ve bought ibuprofen and paracetamol to help. If anyone else has similar issues I’d like to know their thoughts and any advice would be greatly appreciated.

I do have a general mot appointment with doctor when I get home as I also have Graves but rheumatology appointment isn’t until mid June And I’m wondering if MTX might be increased.

[SnazzyD]

Hello, what dose of Pred are you on and how long have you been on holiday?

[Dancesaver in reply to SnazzyD]

Hi Snazzy D, I’m not taking any pred. now, Was told to scale down from 10, 5, 0 However I did it a bit slower and with less jumps. 10,8,6,4, 2&1 Over 4 months. Been here 5 days home in 2

[SnazzyD in reply to Dancesaver]

Just thinking that travel is not to be underestimated because of lifting, movement, lots of sitting often on not the best seats, extra stairs, bad posture etc. Issues with that kind of thing usually set in about day 1-3. Sitting bones, wrists and thighs can get a bit of a bashing. Depending on whether your adrenal glands have got up to full and reliably full function, you may get a few physical complaints from that such as general aches.

[Dancesaver in reply to SnazzyD]

thank you for your prompt and insightful responses. 🙏

[Gottarelax]

Hi I'm lurking in here because I thought I had PMR and also two family members have long PMR. My onset was typical of very rapid PMR but I am seropositive so on the RA treatment pathway. I have the sit-bone and thigh issues that you describe. I think that your rheumy will have to up your MTX dose and it's most likely what they will try first but as far as I understand the GP won't increase dose. For me they took the MTX dose up to 25 mg and then added sulphazalasine. While I was waiting for my initial rheumy appointment, my GP prescribed Naproxen (with lanzoprasole for stomach) which helped a bit. All through this process (once with the rheumy) I have been given the option to use pred as and when I feel I need it so when I'm struggling, I tend to have a tapering course which gives me respite but I'm wary to go on pred long term as I don't want to mask the RA. If you're going to have scans etc, they will probably want you off pred for a short while first.

[Dancesaver in reply to Gottarelax]

hi Gottarelax

Thanks for your feedback, I will probably find this out at next appointment. today my aches are nowhere like yesterday’s which makes it difficult to decide whether to take a pred or not. I’m likening it to be on a boat, one day rough seas next day calm.

[PMRpro Ambassador]

Two points for a start: in PMR, MTX is not a magic answer to reducing pred and certainly won't have worked that quickly even if you are one of the select group for whom it does enable a reduction in pred.

For RA, MTX can take up to 6 months to start to work effectively so it is unreasonable to expect a patient to reduce the pred that fast without problems. Pred is often used to control symptoms until the MTX kicks in but you are also at a lowish rheumatological dose of MTX. And as Snazzy says - you have been on pred at high enough a dose for adrenal function to be a bit shaky.

[Sweetpants]

If your main issue is pain, then ibuprofen, paracetamol etc are just NSaids and may not be effective enough. (Was prescribed Arcoxia 60mg, if you can get it). Mtx is more to prevent swelling in joints, not a pain reliever...

[PMRpro Ambassador in reply to Sweetpants]

MTX isn't pain relief in the basic sense of the term but it suppresses the inflammation which is what causes the pain - so provides pain relief in that way.