Azathioprine or methotrexate

[Rebsy]

Off to see the Rheumatologist in person today. I’ve been taking 40mg pred for the last 12 days following their phone consultation advice. I am sure I’ll be asked to start taking a steroid sparer. I have resisted taking methotrexate. The consultant suggested azathioprine after listening to my concerns. I suppose they are basically the same and each will have their own pros and cons. Has anyone had experience with both? 2 years down the PMR road…seems longer!!

[autumnlass]

In October ‘22 I was in the same dilemma! I settled for MTX as my daughter has RA and side effects were negligible. Although I have PMR it’s working for me and no side effects although I need to rest a bit more that’s all. Didn’t like the side effects of the Azathioprine… but others will come along and guide you … good luck ☘️

[PMRpro Ambassador]

There isn't a lot of evidence for azathioprine being particularly effective in PMR. As with MTX I suspect it works for people who have been misdiagnosed and actually have a form of inflammatory arthritis rather than pure PMR. But like all of the suggestions you have to try to find out if it works.

[krillemy]

I also have a consultation with my Rhemy soon August 7. The plan is to try MTX to see if it could work for me. There has always been some doubt of my PMR diagnosis (5 years in), so I will give it a try as I only 56 years, and that will be many years on prednisolon is it does not go away.

Maybe you could let us know how it works for you! I am so pleased to hear that your daughter has few side effect of MTX as I have always heard that they are dreadful 😅😀

[Rebsy in reply to krillemy]

My new consultant seems very nice and I now have a plan and will start on MTX next week. Following my slightly scary PET scan results it seems to be the right thing to do. I continue on 40mg pred for 2 more weeks and will then start reducing. Regular blood tests for liver and CRP. I’ll let you know how it goes.

[Zampalion]

I had pmr 6 years I came off steroids 2018 had mxt for 2years started on 15mgs mainly due to arthritis never suffered any reaction

[krillemy in reply to Zampalion]

I am not sure I understand you. English is not my mother tongue. Would you try and rephrase it please?

[PMRpro Ambassador in reply to krillemy]

I think it is they have had PMR for 6 years, stopped taking pred in 2018. Took MTX for 2 years with a starting dose of 15mg, mainly because of arthritis, and had no bad reactions to it.

[prairiesong]

I've been on MTX for 2 years and pred for 2.25 years. No side effects with the MTX, but did have to switch to weekly injections when my stomach acted up (even with omeprazole). I've tapered from 25mg down to .5mg every other day. Hoping to make the "leap" to zero soon. Still achy in the mornings and some fatigue, but I think those are the disease not the drugs. My understanding is I will stay on the MTX for a few months after pred ends. I have "normal values" so bloodwork isn't an indicator of PMR, just the pain and fatigue.

Hope this helps. Most of the scary stuff you read about MTX if the much higher doses for cancer treatment. K

[krillemy in reply to prairiesong]

Yes - thanks it does help! I am on 10 mg pred. now and not feeling well. 10 mg seems to be my too low point. I will see next week, but now hope the doctor still wants to go for MTX. ☺️