Review after 2 years

[De-Lay]

I had my PMR review this week. I advised the consultant that I was reducing my prednisolone to 3mg despite feeling pain and discomfort. She then recommended Methotrexate as an alternative and fortnightly reviews. Does anyone have any history of taking this medication and whether it’s worth changing my prednisolone?

[DorsetLady PMRGCAuk volunteer]

As you are down to 3mg after 2years really don’t see the point in changing to MTX -do you mean that rather than adding as well as Pred. Sometimes it’s added as a steroid sparer -but no need at 3mg.

I’m guessing the consultant is on the Pred only lasts 2 years brigade.

What pain and discomfort do you have? Sounds as if you might be a bit too low on Pred.

[PMRpro Ambassador]

MTX doesn't replace pred, you take both and then hope it lets you taper more easily. It MIGHT allow you to get to a lower dose but there are no guarantees. It comes with its own set of potentially unpleasant adverse effects which include increasing your risk of infections and if you get an infection you have to stop it until the infection clears.

In my opinion, any doctor who wants to put a patient on another additional immunosuppressive medication when they are already under 5mg pred after only 2 years needs to rethink their priorities. And Prof Sarah Mackie, a top PMR expert, has expressed a similar opinion!

If you were stuck at 13mg I'd say yes, try it. It works very well for some people. But for the vast majority it isn't a magic bullet, whatever any consultant tries to tell you.

[tangocharlie]

It could be that at 3mg you might actually be on too low a dose to manage current inflammation, especially as you say at that does you are still in pain. You will see many posts on here explaining that it's not all about getting to zero and a fixed reduction schedule, It's about finding the lowest dose that manages symptoms until hopefully the PMR burns itself out and goes away. It's the luck of the draw finding a doctor who knows about treating the complexities of PMR, they might think they know the theory but how many cases have they actually worked with?. As for methotrexate, PMRPro sums that debate up. If it were me, I'd ask more questions, like do I actually need more steroids, what are the chances of methotrexate working in their experience? What are the Benefits, side effects, alternatives and what happens if I do nothing or carry on the same as now? At a low dose of pred it might be feasible to have a PET CT scan which would show how active your PMR is, you'd have to ask your rheumatologist for that, It sounds like s/he is going by textbook experience rather than real life cases. As Dr Mackie is only doing trials now to see if MTX is effective for PMR there is no answer to that yet, it's guesswork and trial and error. Let us know how you get on, whatever you decide to do

[piglette]

If you have pain and discomfort more than usual at 3mg I would increase slight say 1mg as you should be comfortable. It is not a good idea to try and fight through the pain, PMR always wins.

[PolyDiddy]

I tried but it didn't suit me and felt nautious so I have gone back to prednisolene. I am on 5mg having had 'poli' since 2018. I ammplanning to go down now gradually to 1 x 5 then 1 x 4. Will revert back after a month. Good luck everyone. 👍

[DrRon]

I read and process posts and responses that relate to my experience and sometimes add my thought. Today, it's simply to confess my confusion after 5 yrs of PMR. Right now, 3mg/da PRED & 20mg/wk MTX. For one yr I resisted Rheumy's advice to add MTX to help taper my PRED. I was at 15mg Pred at the time. Finally, my hands killed me & Rheumy said that was RA, so I relented re: MTX to treat RA as well as to taper PRED. I am still attempting to taper PRED with some difficulty, pain in the saddle area. I don't even have a question to ask you but if anyone cares to comment, I welcome it.

[PMRpro Ambassador in reply to DrRon]

If you want comments you would be best posting as a new thread for wide coverage.

Could it be iliopsoas bursitis in the groin?