Hopefully you’ll hear from others, but it sounds unusual to start with methotrexate at the beginning. I’ve not heard that recommendation before, but that doesn’t mean it doesn’t happen or wouldn’t work. In my father’s case, that did not come up until months into his taper because his care team considered if it might be best for him to taper off prednisone more quickly.

My hesitation would be that both medications are strong and frequently have side effects, even in the best-case scenario, so to take them together could be unnecessarily challenging. But in my dad’s case, he is extremely sensitive to medication, so we decided not to rock the boat and were able to continue the prednisone taper.