From pred to methotrexate.

[Sjd224]

I'm slowly dropping my prednisolone, and currently taking 20mg methotrexate. When I drop pred completely, with I still have weight issues on the meth? Any ideas?

[PMRpro Ambassador]

Depends. For a start, you may not get off the methotrexate entirely - a few people do but it is by no means guaranteed. I was trialed with methotrexate and I didn't have any of the usual problems with it like nausea but I experienced side effects that are commonly blamed on pred but I'd never had with pred alone. I had joint and muscle pain, sweats and was constantly hungry, I gained a kg in 4 weeks on MTX, with pred I hadn't gained weight, it just redistributed.

Weight loss after pred is a very individual thing, some haven't gained weight on pred, some lose weight on pred, some start to lose weight as the pred dose gets into single figures and lower and others don't lose any until they stop pred altogether. For some it just melts away - others have to consciously aim to lose weight.

[Sjd224 in reply to PMRpro]

When I first went on to the medication, I didn't read up properly, and found myself eating anything and everything. More fool me.

[PMRpro Ambassador in reply to Sjd224]

Which medication? Pred commonly causes that effect but by cutting carbs drastically you can mitigate it. It is unusual for MTX itself to cause hunger, it is usually nausea, but in combo with pred it may make it worse.

[SnazzyD]

I still needed to watch my diet carefully even when off Pred for a good year afterwards. Not as bad as when on Pred but still different to before Pred. Some people find it the cure for their weight issues but I guess it’s down to how different we are with metabolism even on a good day.

Slightly off topic. GCA/PMR aside, the speed with which you get off Pred will depend on how quickly your adrenal function is restored which again is very individual. Methotrexate doesn’t help with that.

[CJ-pmr15]

I am on 20 mg mtx and found that I was able to slowly lose some of my prednisone weight gain once I got below 5 mg pred. Sadly I relapsed at 3.5 mg and am on a higher dose of prednisone again. However I wasn't able to get below 9 mg pred before I was put on mtx.

[Sjd224]

At the hospital tomorrow. Hoping I can reduce the pred, but have to see. Thanks for the reply.