MTX addition. Too early?

[THClover]

New to group. Thanks in advance to all trying to educate. Diagnosed withPMR with GCA components. 18 weeks on Prednisone. Starting at 15mg weaned to 10 mg within 9 weeks. Tried to go to 7.5 but Headache symptoms returned . Resolved going back to 10 mg. After another 3 weeks attempted to alternate 10 and 7.5 every other day. Felt good for 2 weeks then headaches returned. Back up to 10 with 90% improvement after 3 days. MD wants to add MTX. Scared to death of MTX. With 2 failed weaning attempts. Is it too early to consider MTX addition? Is it safe to have one cocktail a week on MTX? Never been a drinker but found alcohol helped with headaches. Sleep with THC supplement.

[PMRpro Ambassador]

Hi and welcome!

If there are "GCA components" - why were you started in a pred dose that is the low end of the PMR ramge? It may have been enough as it turns out - but once you get to 10mg, the recommendations in all tapering suggestions are for 1mg per month at most.

If they were a bit gentler in their approach they wouldn't end up trying to force patients to take another drug!!

This is a taper approach that reduced the flare rate from 3 in 5 to 1 in 5:

rcpe.ac.uk/sites/default/fi...

And they keep patients at 10mg for a year!

[THClover in reply to PMRpro]

Appreciate response. Probably started low as I didn’t want to admit I had the headaches at first. Scared! But once symptoms improved at low dose, I felt probably wasn’t as bad as others reported.

[DorsetLady PMRGCAuk volunteer]

Hi and welcome,

If you have “GCA components” then you probably need a higher dose of Pred… and what components.

Whatever you have 10/7.5mg reduction is too harsh on body - as is the alternate day approach [which seems to be very popular on your side of the pond] it to be much slower tapers…below 10mg the guidelines suggest 1mg reduction over 4-8 weeks,… depending on disease activity and patients wishes.

If you are being reduced sensibly there is probably no need to add in MTX.

You might like to have read of this intro/info post-

healthunlocked.com/pmrgcauk...

Plus this re CBD -

healthunlocked.com/pmrgcauk...