Evening all, hope you are enjoying a nice weekend 🤗I am currently tapering my Prednisolone since Jan this year. I'm tapering from 10mg using the DSNS tapering plan over weeks. Currently on week 3 of taper from 8.5mg to 8mg. In that time I have been up and down a bit, some small flares and always some aches which would leave me during the morning time. As I was having some difficulty with the taper, my Rhumatoligist put me on 10 mgs of Methotrexate, once per week. I found in this time that the methotrexate didn't seem to be if much help to me. I still experienced aches and pains and flares occasionally. The only side effects from the MTX seemed to be some cramping and diarrhea/loose stools for the first 2 / 3 days following the dose. My bloods were showing up ok.
I rang my Rhumatoligist a couple of days ago and explained that I didn't feel any significant aid from the MTX and that ZI felt the DSNS / 7 week taper worked for me. She agreed that I could stop the MTX and continue with my slow taper outlined on this site. She said we'd review this situation in a few months. I'm happy with that. Today and yesterday my PMR has been good, weather also improved !
Should state that I have PMR since April 2020. Started on 15mgs Prednisolone.
After all that my question is can I just drop off the MTX without tapering from it? She didn't say I needed to taper. A friend said that she thought I should taper off the MTX?
What would you suggest please? 😊
Written by
lkcreedon
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No - no need to taper the MTX and in fact that was a very low dose even for rheumy use so maybe it isn't surprising you didn't feel it made any difference. Hope you don't find it WAS holding something at bay though - has been known!
Just to add to Pmrpro’s point, my latest rheumy told me that studies have shown that less than 20mg MTX isn’t that effective for PMR steroid sparing/ inflammatory arthritis -he increased my dose to that level per week. So if you do reconsider MTX, it might be worth going higher if you can tolerate it.
Thanks Ryan33. I'm very uptight about it all at present. I will see how I get on over the next few months and review then. If I can drop down in the steroid using the DSNS taper I would prefer that. Worth trying I think. Thanks for your response 😊
I was on 10mg MTX from December 23 to April 24 and found no benefit. Also, I was told on this forum that blood tests were needed if using MTX, so I stopped using the MTX.
I really wouldn't want to be on a higher dose of MTX, my fatigue was worse while using it.
I have tried a few times to reduce dosage of preds from 20mg... now on 3rd attempt. My second attempt I postponed, as my immunologist suggested I wait until gut in a better state.
I'm like you, I'd hate to be on a higher dose if at all possible. It's such hard thing to get down in the steroid. I did have all the required blood tests and they were all ok. The only side effect I seemed to have was cramping and very loose stools for the first 2 or 3 days each week after taking the MTX. I am going to take the taper very slowly now. From the information on this forum it appears that that is the way to go. Best of luck to you on your own taper 😊
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Any advice on tapering prednisolone with Methotrexate and RoActemra?
Methotrexate 
Methotrexate or not? 
To taper tonight or not to taper.
Tapering
