Why does my rheumatologist want me to go onto Methotrexate when I am on a low does of Prednisolone and am getting good symptom relief?

[Siena62]

I am now down to 2mg of Prednisolone a day. From a few weeks in my rheumatologist has wanted me to go onto Methotrexate. I have never achieved total symptom relief and recently I've probably been slightly stiffer than before, certainly in the mornings. My last blood tests showed that my CRP had gone up to 8 from 5 and my ESR had jumped from 17 to 30. I am due to have repeat blood tests. My CRP has remained at 9 or under since starting Prednisolone apart from once early on but my ESR has fluctuated and has gone up significantly when last tested.

One of the things that I'm annoyed about is being repeatedly warned about the risk of Osteoporosis and yet I'm on Omeprazole! I stopped the AdCal when I went down to 5mg of Prednisolone a year ago but was told in no uncertain terms to start taking it again.

My BP and Cholestrol have both gone up and I'm now on both Indapamide and Ramipril as I'm struggling to bring my BP down (I was on BP medication before starting the Prednisolone). I'm hoping the the blood tests that I'm due to have don't shown raised blood sugar as well.

My rheumatologist thinks that even low doses of steroids are harmful. I think that she's not totally confident about my diagnosis and I wonder whether she's pushing Methotrexate because she is worried that I have RA instead (or as well).

I don't want to go on Methotrexate for various reasons not least the fact that she is very vague about the likelihood of me actually coming off Prednisolone completely within a reasonable timeframe. I certainly don't want to be on two tough drugs long term.

[PMRpro Ambassador]

She is obviously totally bigoted about pred and pro-MTX - despite the fact that it is not guaranteed to get anyone totally off pred if they have PMR. I asked my rheumy the other day about the recent rash of "short sharp shock" approaches with pred I have come across - his view: if it disappeared in a few months or less, it wasn't the PMR we talk about in the first place. And he is probably the leading light in the PMR world at present. I think the same applies to MTX if the truth were told. If you are at 3mg or less (though it does sound as if 3 might be better than 2) then adding in MTX is crackers, Immunologists are concerned about the way some rheumatologists use multiple immunosuppressant drugs together and are concerned about the long term effect on the immune system.

I would seriously consider finding another rheumy for an unbiased opinion. There is a role for MTX, it is NOT for the patient who is well below 5mg.

[DorsetLady PMRGCAuk volunteer]

Really don't see the point in adding in MTX when you are down to 2mg...and in under 2 years. there are many on here who would love to be that low in that timeframe...

[PMRpro Ambassador in reply to DorsetLady]

I'd like to be that low in ANY timeframe!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Absolutely - methinks a certain Rheumy needs to get out more!

[PMRpro Ambassador in reply to DorsetLady]

Definitely - she isn't alone though!

[Jackoh]

As said before, not a case for adding Methotrexate to the mix, in my opinion. 💐

[Bramble2000]

Personally, I wouldn’t be adding M. You don’t have to, stand your ground!

[cranberryt]

Every rheumy I have seen has pushed it. But I refuse. I am at 1.5mg and to me there is no sense in starting other drugs with their own serious side effects when my dose is so low.

[PMRpro Ambassador in reply to cranberryt]

Quite right - and Prof Mackie agrees with you

[Joan-E-D]

My rheumy tried to put me on Methotrexate when I was at 5 mg Pred. and reducing fairly steadily. I refused too and managed to get to zero 9 months later. That was in 2019 and so far the PMR hasn't come back, touch wood. When I asked him why he said he was worried that my adrenals wouldn't function if I didn't reduce Pred. more quickly. I had no trouble with them even on lower doses.

[sidra1968]

Mine also suggested it (when on 22.5 mg) and I refused - I said I didn't want to add another drug to the mix when I was finally feeling good, but that "I'd keep it in mind"..basically "thanks, but no thanks"