Methotrexate

[Golden20]

Hi everyone,

How daft am I. I really thought I’d almost kicked my PMR into the long grass, after tapering down to 1.5 mg after 6 years. Pride and fall come into mind. My rheumatologist has been dutifully trying to get me to take MTX along with Pred. I’ve resisted it for 2 years. My latest flare on 1.5mg was almost the same as my very first bout of PMR. I really didn’t want to introduce any other drug to help, thought as I got to such a low dose I’d cracked it! I’d really appreciate it, if anyone has any tips on starting MTX. I’ve read up on it and many people say to start it before bedtime, to help alleviate some of the side effects. I’m back on 2.5 mg Pred, which I take at breakfast. The plan is to decrease the pred with the aid of MTX. I admit to being nervous about it. Have to give it a try, I guess. Thanks for reading this.

[PMRpro Ambassador]

If I were managing well on 3mg or less I would refuse to introduce a drug like MTX. The potential adverse effects compared to those of low dose pred make it a rather questionable approach. Experienced PMR rheumatologists agree with me. There is no guarantee that MTX will get you entirely off pred and it takes months to really see of it is working to do so, some say up to a year, It can be an unpleasant drug so I would say no thank you,

[PMRrunner]

I agree with PMRPro I wouldn't have started on first leflunomide and then methotrexate if I had managed to get as low as 3mg prednisolone. I struggled getting below 10mg and even with the addition of methotrexate my tapering regime has been very very slow.I take my methotrexate late evening partly to alleviate the nausea side effect but also I find if I take it earlier in the day I struggle sleeping that night.

Hope whatever you decide helps

[Louisa1840]

Hi Golden,

I agree with PMRpro. I would be SO happy to be as low as you on pred. It may be that we can't get off pred entirely but, to be as low as three mgs I really wouldn't be bothering too much and I certainly wouldn't want to introduce another toxic drug. I tried MTX many years ago and I wasn't impressed with the side effects. I say carry on with your 3 mgs , concentrate on a healthy lifestyle and a positive attitude. You could try reducing by just a quarter to see if that will get you lower but, really just relax and don't become fixated on getting off pred entirely as it may not be possible for you just yet. One day maybe..?

[harpsichor]

I’ve been injecting MTX weekly since December, I’m 77, and I’m taking 4mg prednisolone. I take folic acid prescribed by the rheumatologist every day except the MTX day. I haven’t had any side effects - I even managed to carry a very heavy suitcase (more than 13kg, containing amongst other things a C flute, an alto flute and a music stand) and backpack on a 5 hour rail journey with changes this last week, and did an even more exhausting return journey three days later, because as we approached Leeds, they told us we weren’t stopping there. They let us off in York, and I got on the wrong train there and went to Doncaster by mistake! I got back to Leeds in the end. I have been told that I have adrenal insufficiency, but I was surprised that I coped with all that, although I have felt quite tired this week. I just wish my rheumatologist would give me the go-ahead to reduce the 4mg prednisolone dose. But the MTX does not seem to be affecting me adversely at all, as far as I can tell.

[cranberryt]

I have been in this position with rheumy insisting on introducing new drugs under 5mg. I personally refuse them. Some stay on 2mg maintenance dose permanently to avoid relapse. I am at 1.5mg and will not be pushed into steroid sparers at this point.