I took methotrexate as an adjunct to prednisone. In my case, it was used as a steroid sparing medication. It was the first medication used in an attempt at getting my prednisone dose lower.

My experience with methotrexate mirrors your experience. It worked for lowering my prednisone dose. I tolerated methotrexate for about a year until my liver enzymes increased. It gradually made me nauseated to take it. Then I developed "morning sickness" because I retched every morning when I woke up. My rheumatologist scoffed at my morning sickness and she insisted methotrexate was working for me. I eventually decided to discontinue methotrexate myself.

A couple of years later, my rheumatologist wanted me to try methotrexate again. I took it for a few weeks the second time but I would retch whenever I attempted to put it into my mouth. I think it was an aversion to methotrexate.

I admire anyone who can take methotrexate because it does work for some people. Its effectiveness for PMR has mixed results.

My rheumatologist also wanted me on methotrexate for preventing my body from developing antibodies to my biologic Actemra. I think my expression was all it took for my rheumatolgist to decide not to start it for a third time. The idea was nixed and wasn't pursued. As far as I know, I haven't developed antibodies to Actemra. How do they test for that? Actemra still seems to work for me so I doubt I have developed any antibodies against it.

I have minimal if any side effects from Actemra and got completely off prednisone. Prednisone came with many side effects. I think there might be a greater risk when Actemra and prednisone are used in combination. This seemed true for almost any medication I took with prednisone for its steroid sparing effects. Fortunately, I was able to taper off prednisone relatively quickly after Actemra was tried.