methotrexate

[Creamtea]

just had a flare on reducing from 5mg prednisolone to 4.5mg.

my whole body hurts. Crp 9.

rheumatologist wants to put me on Methotrexate. I am concerned about side effects. Should I be worried ?

[Nextoneplease]

Hi Creamtea 😊

I haven’t been on methotrexate myself so can’t comment from experience on side effects. I do wonder though why the doctor wants to put you on another drug when you’re already on a fairly low dose of pred.

How long have you been feeling this bad? Could it be a flare? Maybe treat as such and increase your dose on a temporary basis (max 10 days)?

Another thought: has your rheumatologist suggested that you may have another condition such as rheumatoid arthritis?? That might make more sense of the idea of methotrexate.

Can you give more information please? I think more is needed in order to give you a better reply.

Hang in there, others with more knowledge will be along soon xx

[PMRpro Ambassador]

I wouldn't bother if it were me. A new study has finally shown rheumies that MTX isn't the magic bullet they seem to think - despite the 3 studies they base its use on being contradictory and far from convincing. However - for a small proportion of PMR patients it works brilliantly so you have to try it to find out if you are one of them.

But your history is a bit more complicated than just PMR isn't it? You have been on leflunomide when the GCA was diagnosed - how did you get on with that? But above all - 5 months ago you were told you have adrenal insufficiency, although that isn't surprising when a synacthen test is done at 5mg as that is lots to suppress cortisol production. Of course, that will only change if you can get to a lower dose of pred and stay there - I assume that is your rheumy's intention in adding MTX?

SInce you have GCA, can they not put you on tocilizumab? That does work for pred reduction in GCA/PMR and since you do get it for at least a year in the UK it would give your adrenal function a chance to recover without messing about with MTX first?

[Creamtea in reply to PMRpro]

Thank you for your reply Pmr pro. I am very unsure as to whether to take it looking at the side effects and as my crp is only 9. I think I’d rather just up my pred for a bit and see if that works. Plus there is all the blood tests have to have and it’s difficult to get booked in for them.

[Creamtea in reply to Creamtea]

Yes I was on leflunamide but that caused diarrhoea.

[PMRpro Ambassador in reply to Creamtea]

Not every one gets the adverse effects and never all of them. But they need to consider whether it really is worth it - given the increasing evidence that it really isn't very useful in the context of PMR and GCA, whatever they try to tell us.