Reducing prednisolone with Methotrexate- what happens after?

[Smithie49]

I am on 7 mg pred for PMR and it just about controls my symptoms though I get quite stiff in my hips and neck. I reduced to 5 mg in early 2022 having met my condition first in June 2021. I think I reduced too quickly and have since had several flares. My rheumatologist wants me to start methotrexate which I have delayed until Jan so I can enjoy Christmas with my family. I am very wary of taking an extra drug and really don't fancy the possible side effects. My question is, what happens if methotrexate does enable me to reduce the amount of pred? Do I then have to continue with methotrexate? From what I've read here, stopping both just invites our old pal PMR back into our lives. 😞

[DorsetLady PMRGCAuk volunteer]

Well as your PMR is only 2.5 years in- and as we know it can last a lot longer, and if 7mg only just controls things...would say it's still very active. I'd be concentrating on getting the correct level of Pred first, and avoiding the MTX personally.. it does work for some but certainly not all. and as you say has it's own set of side effects.

I think I might try 8mg until after Christmas.. and then may try MTX - then at least you can say you have tried.. it might work it might not...

but personally think a slower taper as we talk about all the time and 0.5mg reductions is the way forward -

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

As for- From what I've read here, stopping both just invites our old pal PMR back into our lives. 😞-

only if it hasn't gone into remission - and neither the medication, nor you nor the doctors really know that until you've been off Pred for a few months and no return of symptoms.

Too fast a reduction before remission is often when PMR comes calling again...

[PMRpro Ambassador]

Depends on the person - whether MTX works at all for you and you tolerate it. It doesn't always work though when it does, it can be brilliant.

Take each stage at a time - first see if the MTX is worth it. If you get off pred while taking it, some doctors leave you on MTX for some months and then taper the MTX. Others have other ideas. Cross the bridges as you get to them. First, settle on the MTX and be sure you feel OK. Because if you DON'T feel OK and at least as well as you do on pred, there is no point in suffering with the MTX.

[PMRrunner]

I've just replied on another post about taking methotrexate as a steroid sparer.I've had PMR for over 5 years and have been on Methotrexate for around 2 years. For the first few months on Methotrexate I didn't reduce my steroid dose at all, since then I have reduced very slowly - .5mg over a period of around 8 weeks. I'm currently on 10mg of methotrexate, I had issues with nausea and tiredness at 15mg.

I'm not sure what happens if and when I get off prednisolone, possibly take methotrexate for some time before stopping. If I find that I have to stay on a low dose of prednisolone then I may see if I am ok on a low dose without the Methotrexate.

Hope this helps

[Smithie49 in reply to PMRrunner]

Very many thanks for that. It really helps to have other people's experience

[dancersize2]

My rheumy put me on MTX in 2019 when I was stuck at 6.5mg pred for 6 months. It did enable me to get to 2.5mg pred in a year then I continued the taper very slowly. Finished pred in 2021 and rheumy said stay on MTX. I'd reduced to 15mg weekly of MTX by then and I chose to reduce to 10mg MTX. Last April I had sudden pain return and was told I now have rheumatoid arthritis so stay on MTX. Have upped dose to 20 again but split dose because it makes me nauseous. Hoping to reduce to 15 MTX again. Best wishes with whatever you choose to do. Keep up moving if you can. I do ballroom dancing and it helps a lot.

[Smithie49 in reply to dancersize2]

So sorry to hear you've developed RA. Is that yet another auto immune condition? Good luck with that and keep dancing 💃