pred plus methotrexate?

[Di1863]

Tapered, slowly, to 3mg of Prednisolone.Stiff and achey legs and hips in the morning but gone by afternoon. Saw rheumatologist today who wants to increase pred to 6mg and add 15mg methotrexate once a week. Will review in 6 weeks. Inflammation levels in blood are high - 18 - would that be good reason to follow her plan?

[DorsetLady PMRGCAuk volunteer]

See you were on 5mg about a year ago and your Rheumy was suggesting MTX at that point. ..so I guess you rejected at that time.

Maybe try the 6mg as suggested, but I’d hold off on the MTX until you see if the increase in Pred helps.

.. or as PMRpro suggests try the flare protocol -

healthunlocked.com/pmrgcauk...

[Di1863 in reply to DorsetLady]

Thank you! I have refused max twice before….. will try and refuse again! So difficult to know what to do for the best isn’t it!

[DorsetLady PMRGCAuk volunteer in reply to Di1863]

It is difficult- that’s why are here to help when we can….

[PMRpro Ambassador]

It is certainly a good reason for increasing your pred - you have probably overshot the dose you need and are having a flare of symptoms as a result as the inflammation building up as it isn't all being dealt with on a daily basis. But I would go about it differently.

We suggest the following to deal with such a flare:

Add 5mg to the dose where you flared for 7-10 days and then drop back to the dose where you were last good. That could well be 4mg if this slow response to the pred has only just started. Have you had the symptoms for long? If so you would take 8mg for a week or so and return straight to 4mg

If that works, then I personally see no reason at all for adding methotrexate at this stage. And I know some top experts in the PMR/GCA world who would agree with me. MTX isn't guaranteed to work for everyone and has its own disadvantages and adverse effects. It makes some people quite unwell. And at 4mg you are at a low dose anyway.

[Di1863 in reply to PMRpro]

Thank you for this sound advice. I have upped my dose to 6mg and have noticed the difference in only a couple of days. I will stay here for a week or so then drop back to where I was. The only worrying thing is my high levels of inflammation- is that why mtx has been suggested do you think? I am really not keen on taking it.

[PMRpro Ambassador in reply to Di1863]

If that works enough, that is fine, But don;t drop back to a dose that is too low or you will just end up in the same situation. Stick at 1mg above where you got in trouble and be patient. And MTX? You can just say no you know.

[Suet3942]

I’m down to 3mg and same problem. My new rheumy wanted me to increase but I’m resisting at the moment. It’s taken so long to get to a low dose. 🤔

[Di1863 in reply to Suet3942]

It is so difficult to know what to do for the best isn’t it! I have given in and upped my pred to 6mg and I have to say the pain and aches have all but gone. Not sure how long I should stay on this dose and really don’t want to introduce mtx but maybe that’s the only way to get my high inflammation levels down. I hope you continue to get your dose down with no ill effects. Good luck!

[PMRpro Ambassador in reply to Di1863]

If you are doing well at 6mg, it is not really a good idea to introduce such a powerful drug at this stage. It has its own downsides and is not guaranteed to get your pred dose lower, If you were stuck about 10mg that would be different. But patience often works just as well.