Methotrexate

[Maggieart]

Has anyone had success with methotrexate?

[DorsetLady PMRGCAuk volunteer]

Plenty of information in FAQs and also related posts now you have asked the question -

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

Now you have posted you will see at least 10 Related Posts - when you look at one of those there is likely to be a different selection of Related Posts for that one. Worth having a look at them. There is also a section on Methotrexate in the FAQs, linked at the top of every thread.

What do mean by success? How has methotrexate been sold to you by your doctor?

It rarely replaces pred altogether, although some people do taper off pred while on MTX but who knows - they might have been able to do that anyway by going about the taper slowly and carefully. It does work brilliantly for a small cohort of PMR patients - either they have a very specific form of PMR or it wasn't PMR in the first place but a polymyalgic presentation of an inflammatory arthritis of some sort. MTX is the first line approach for inflammatory arthritis and has been for over 30 years. But PMR is not an arthritis.

For a lot of others it may smooth out tapering, fewer hiccups on the way down - but again, the way we encourage tapering also avoids unnecessary flares. And for a sizeable number, they feel so unwell or have intolerable side effects such as hair loss, that they stop taking it sooner or later.

It inevitably adds another layer of side effects - for some it makes pred effects worse, for others the nausea is too much although it is claimed that switching to injections rather than tablets sorts that out. It makes you more susceptible to infections and you have to miss the dose if you have an infection and that may result in the tapering effect being not so good if you have a lot of infections. It goes for the liver - and then you must stop it. It may also cause lung problems.

It is a personal thing, some rheumies do a big sell that is rather optimistic, Some tell you most rheumies would choose to take MTX rather than pred - but that suggests to me they haven't actually tried either themselves! Some patients think it is worth it, others don't. You have to try it yourself to know if it works for you or if you will feel awful on it. But you can just stop it without tapering if you don't get on with it, unlike pred. But at least pred works for PMR!

[redruth123]

Hi Maggieart My 'success' with it was that after a year of being on pred for PMR I began oral 10mg weekly of MTX and immediately had reduced fatigue and reduced stiffness.

A lot of the joy of life came back and I luckily suffered no side effects. Regular blood tests are essential to see if any hidden side effects are occurring.

Against doctors orders though, I did NOT taper pred quickly and in fact took the next 2 years to go from 7mg to zero pred. During that taper, osteo arthritis symptoms reared up strongly so am back in pain etc but I dont regret taking the MTX. So I was one of the lucky ones with this drug. It's very individual and scary at the beginning because of the potential side effects Luckily it is a drug you can stop immediately if necessary. All the best.

[WaltzG]

Yes ! On it instead of steriods and working for me.....Good luck

[autumnlass]

It’s working for me! As previous posts have answered all the queries I would totally agree with! It’s changed my life and brought back joy again! I was very nervous at first but the pharmacist said ‘it can be a miracle for some’ .. and for me it has been!! Good Luck! 🌸

[Balletomane]

I couldn't get below 10mg prednisolone, GCA not PMR tho, until started taking methotrexate as well. Then OK and now down to 3mg pred