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New Diagnosis of Polymyalgia Rheumatica (Husband)
Polymyalgia Rheumatica (PMR) | Last Active: Feb 29 2:49pm | Replies (102)Comment receiving replies
@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
Replies to "@prestol Why, in 2024, would you go the route of MTX , may I ask? i..."
Methotrexate is commonly used in Australia for PMR patients who do not respond well to Prednisone or are having difficulty tapering. It is a requirement under our health care system that the cheaper DMARDS are tried for at least 6 months before an application is made for Actemra to be approved under the Pharmaceutical Benefits Scheme. If you want to bypass this frustrating process you have to pay over $4000 per month to access the medication.
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Actually, I am a big fan of biologic drugs! I have been taking one (inflixamab, brand name Inflectra) for many years to manage Crohn’s disease, with total remission for past 12 years and no side effects. I have been told I cannot take an IL6 inhibitor in addition. I am quite resistant to going off the inflixamab, and will be speaking with my gastroenterologist soon about alternatives. I don’t think there is anything as effective. As for the PMR, I need an alternative to prednisone because I have osteopenia (before treatment, full-blown osteoporosis), and my rheumatologist says MTX is the best option. No decision yet, and I remain on pred 30 for at least another week before attempting to taper.