"Methotrexate is given as an adjunct drug to disease modifying biologics because it has a multiplier effect - both drugs are more effective together than alone."

With PMR, methotrexate is used mostly as a "steroid sparer." I took methotrexate for about a year and it spared me the use of some prednisone. I was able to lower my Prednisone dose somewhat. My rhematologist thought it was helping me so she did everything she could to convince me to keep taking it. She kept increasing my methotrexate dose. My liver enzymes ruled the day and I stopped taking methotrexate much to the chagrin of my rheumatolgist.

When Actemra was tried, my rheumatologist said methotrexate might reduce the risk of me forming antibodies to Actemra. He didn't seem convinced that methotrexate would be beneficial otherwise. He did mention that methotrexate failed in his request to get authorization to treat me with Actemra. He said "all other alternatives failed' but only mentioned methotrexate. There really weren't very many alternatives other than methotrexate and leflunomide. The other failed medications were used to treat reactive arthritis.

"Failure to taper off prednisone" was the single biggest reason for wanting to try Actemra.

I did have the opportunity to try Humira for the uveitis that flared while on Actemra. Uveitis flared up almost as as soon as I got off Prednisone. My opthalmologist said Humira was optimal for uveitis. She tried to discourage from going back on Actemra. She said it would only be a matter of time until I had another flare of uveitis.