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New Diagnosis of Polymyalgia Rheumatica (Husband)

Polymyalgia Rheumatica (PMR) | Last Active: Feb 29 2:49pm | Replies (102)
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@prestol

Kate, you are lucky. Sounds like you have a great doctor. June, I am sorry you are not reacting well to prednisone. I too started at 15 (one month ago) and am now at 30. My side effects are fluid retention and insomnia. I saw my rheumatologist yesterday for the second time. She explained that you need enough prednisone to really zap the inflammation which is causing your pain, otherwise you risk a bad flare and will be starting all over again. I will manage my own tapering schedule, but she encouraged at least two weeks at each dose. I am on 30 mg and will go down by 5 mg each time. When I am below 20, I’ll start methotrexate and try to get off the prednisone. Good luck, both of you.

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Replies to "Kate, you are lucky. Sounds like you have a great doctor. June, I am sorry you..."
juneannetteayres | @juneannetteayres | Feb 21 2:57pm

My doctor is extremely thorough. I am staying at this dose for three weeks then have another blood test to see if my inflammatory markers are reducing if so I will be able to titrate down but have also been for referred to a Consultant re query inflammatory bowel disease

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nyxygirl | @nyxygirl | Feb 28 3:01pm

@prestol Why, in 2024, would you go the route of MTX , may I ask? i have been trying to keep up with literature and anti-IL-6R drugs are available as you probably know.
I needed >20mg dose to completely rid me of the morning stiffness and pain in both shoulders and hips .
there is a summary of the Great Debate of steroid vs biologicals in PMR in the thread about the Nov 2023 ACR meeting. attached here: https://connect.mayoclinic.org/comment/1012486/

quick google search found this :
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9012047/.

However, based on this sparse evidence, the current European League Against Rheumatism / American College of Rheumatology (EULAR/ACR) recommendations for the management of PMR advise an early introduction of MTX in patients with worse prognosis such as in patients prone to relapse or prolonged GC-therapy, as well as in patients where GC-related AE are more likely to occur [4, 7, 25]. In clinical practice, however, MTX is infrequently used, as reported by a national database study of Albrecht et al., who found that only 19% of patients with PMR received concomitant MTX [10]. This curbed use may reflect the uncertainty of the exact role of MTX in PMR, due to the limited and conflicting evidence. Therefore, further research regarding the use of MTX is high on the research agenda of the 2015 EULAR/ACR guideline for the management of PMR

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