Slow trudge to the finish...

[Marijo1951]

I had a video appointment with my rheumatologist last week. It's a good thing that it was a video appointment as I was in the grip of a very heavy and disgustingly snotty cold. I would have felt irresponsible going to the hospital even wearing a face mask.

I hadn't taken pred at all since August with no symptoms reappearing, but did continue with the weekly 10 mg of Methotrexate as instructed in my last appointment. I fully expected to be discharged and off all meds, but the consultant said she wanted me to continue the 10 mg of MTX to "carry me over the winter", but to cut my Folic Acid dose from 5 times to once a week. I have an appointment in February, in which she said we'll discuss bringing the dose down to 7.5 mg.

I wasn't at my brightest during the appointment, so didn't ask for more of an explanation, but I am wondering why she should want me to continue with the MTX and why it's to "carry me over the winter". I should have thought that since MTX impairs the immune system to some degree, coming off it would contribute towards me avoiding further colds etc. Also, I've been told before that 10 mg per week is the minimum effective dose so what's the point of continuing with a lower dose? Can anybody throw any light on this?

[PMRpro Ambassador]

Surprised she cut the folic acid so drastically but no doubt she's done this before.

There does appear to be a degree of seasonality to PMR hence "the carry you over the winter" comment I suspect. Is the 10mg minimum effective dose for PMR or for MTX as a DMARD? Not something I have heard before - but its effectiveness is, at best, variable in PMR anyway. However, she maybe feels removing it gradually is more likely to avoid pitfalls.

[Marijo1951 in reply to PMRpro]

I was told that 10 mgs is the lowest effective dose a couple of years ago by one of the Junior Rheumatologists at the same hospital. She said they didn't prescribe anything lower as it was pointless.

[Rachmaninov2 in reply to Marijo1951]

Just shows you how opinions vary, my rheumatologist agreed that I could start with 7.5mg Methotrexate and increase if necessary.

[PMRpro Ambassador in reply to Rachmaninov2]

I think it is different with PMR where it isn't acting as DMARD, but hoped to potentiate the effect of pred - as an interaction.

[Rachmaninov2 in reply to PMRpro]

Ah, thank you. My Rheumatologist is uncertain as to whether I have Inflammatory Arthritis, PMR or both. I think both, but hoping my appointment with a Pain Management consultant tomorrow following an MRI will help to make things a bit clearer.

[PMRpro Ambassador in reply to Rachmaninov2]

I forgot to say, it also seems to help avoid difficulties with MTX by starting with a low dose and working up but not many rheunies seem to bother.

[Rachmaninov2 in reply to PMRpro]

My original rheumy wanted to start higher but could see how apprehensive I was, so agreed to begin with what he termed a child’s dose. I think much more sensible than starting too high and the potential side effects putting the patient off altogether.