Information on methotrexate please.

[Tappo]

Hi all. I have looked through the FAQ and cannot find the specific information I’m looking for. I think it is because it is buried within the threads of general questions about methotrexate. It was about the use of methotrexate for PMR and it only working if it affects a certain interleukin. I think it might have been PMRpro who has mentioned it and wondered if she would mind sharing it again. Many thanks.

[piglette]

Methotrexate is primarily a drug for rheumatoid arthritis and is the main drug used. Interestingly enough it came into being from a drug set up for children with leukaemia which was introduced in the 1940s. It was found that Methotrexate did help people with PMR and started to be given as a sparer. However it does not seem to work for everyone and can be a bit hit or miss.

[Tappo in reply to piglette]

That’s very helpful piglette. Thank you.

[PMRpro Ambassador]

I don't really understand what you are asking - but PMR is mainly caused by IL-6 but there are a couple of other mechanisms for inflammation that also seem to be involved, they are known to be involved in GCA and almost certainly are part of PMR.

sciencedirect.com/science/a...

MTX mainly is expected to have a generally suppressive action on the immune system - there is little in its mechanism that is specific to PMR/GCA although some lowish quality past studies suggested there might be some steroid-sparing effect after a year. This has been siezed on by rheumies but in real life it is apparent that it works well for a small number of PMR patients and you have to try it to see if you are one. I think it works for one particular underlying cause of PMR symptoms which is probably more akin to an inflammatory arthritis. As long as it is used with that in mind it is fair enough to TRY it provided it doesn't make the patient suffer its own adverse effects. I have had few pred effects - MTX was awful, I lasted a month!

There is at last 1 high quality study in the Netherlands that is likely to contribute to erasing MTX from the general armoury and more are expected which may help (or not!)

acrabstracts.org/abstract/r...

rheumnow.com/news/say-goodb...

The past history of MTX use is discussed here together with potential replacements

academic.oup.com/rheumatolo...

Does this help you? Ask something more specific and I'm happy to contribute to a discussion.

[Tappo in reply to PMRpro]

Thank you for your very comprehensive replyPMRpro. As the title of my post said, I was asking for information on methotrexate. Hence you have very my question.🥰

[Angelsmummy]

Morning T,I have GCA/ PMR,was put on MTX after flaring,horrid,nasty side effects ,DEFINATELY not for me,couldn’t get off it quick enough.BUT you may be lucky.All a matter of personal choice.I now am taking the route of very very slow tapering with the Pred and keeping my fingers crossed,as really don’t want to add in any more drugs if I can possibly help it.Good luck with what you decide.xx🌷😜

[Tappo in reply to Angelsmummy]

Thank you for your reply. I’m just arming myself with information before my rheumatologist appointment this week 🥰