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I have just been diagnosed with PMR and as a diabetic that I'm controlling with diet and not so much exercise right now I've opted to go with methotrexate rather than prednizone to minimize glucose spike and have to look to insulin. Starting first dose tomorrow. Any insights? Biggest downside for me is not being able to be in the sun without precautions. What can I expect with side effects and do they diminish as the doses continue? What are you doing for pain management until inflammation starts to get under control? Any response is greatly appreciated. This is one crazy roller coaster ride!
Replies to "I have just been diagnosed with PMR and as a diabetic that I'm controlling with diet..."
I took methotrexate to try to reduce my prednisone dose. It worked for that as I was able to reduce from 8 to 5mg after being stuck at 8 or higher for 2 years. The side effects were bad for about a month: nausea, headaches and just not feeling well. The methotrexate worked for 5 months, then I got a disease flare-up. The methotrexate also caused my liver enzymes to be high, which means damage to the liver is happening. I'm now taking Kevzara and prednisone. From my experience and everything I have read methotrexate does not work as a sole treatment for PMR. The pain and symptoms of PMR I had could not be endured without treatment. I could barely function, was spiking a fever on an almost daily basis and developed the temporal headaches that can be a symptom of giant cell arteritis, a more serious disease. My impression is that some people have a less severe case of PMR and other approaches may work.
Hello, I have been a diabetic for about 12 years, it is genetic in my family. However, I also have a long intermittent history of prednisone use of over 50 years! My history includes Asthma, Reactive Arthritis and now PMR.
I have taken methotrexate and Arava in the past with prednisone. I take 2000 mg of metformin a day for my diabetes and I’m currently on 7.5 mg prednisone and getting ready to start Actemra. So far I have had no need for insulin. Prednisone is unfortunately the drug that really gives almost instant pain relief for arthritis and PMR. I would discuss this with your PCP and Rheumatologist and they can address your concerns. Really I believe you should do well since you said your sugar is under control with diet.
Good luck!
As an add on to my previous comment, you might try using the topical pain crème, Aspercreme. The original formula, 10% Trolamine Salicylate, NOT the lidocaine formula, works for my shoulder and upper arm pain.
There is a brand new YouTube video that discusses this in depth. At 32 minutes.
https://www.youtube.com/watch?v=mWBPr-zZI44&t=106s
The doctor stated that it takes 6 months for methotrexate to work. I take Plaquenil instead. I do drink some alcohol so I avoid things that damage the liver, like Tylenol
I fell off a cliff with PR as he describes, one day playing pickleball, the next day can't walk or get out of bed.
@tuckerp They think I have a combination of PMR and RA. I am alone in this and shouldn't ask you but would you try it? I have been battling weakness and fatigue — really profound for several weeks. Better today for some reason. Thanks so much for responding.
Hello @cwadamssc54, Welcome to Connect. You will notice that we merged your discussion with the following discussion on the same topic. If you click the link, it will take you to the beginning of the discussion where you can learn what other members have shared on using methotrexate for PMR.
--- PMR and Methotrexate: https://connect.mayoclinic.org/discussion/pmr-and-methotrexate/.
It's been a few days since you posted. How is the methotrexate working for your PMR pain management?
I've not met someone who started on methotrexate instead of prednisone, although it makes sense. Let us know how it's going.
I have an inflammatory arthritis, but I know others who have been on methotrexate and while prednisone definitely has its down sides, methotrexate did not sound like a picnic either. Even my dad's rheumatologist said: "Well we could use it to help you taper off prednisone, but that will present a whole host of other problems..." We stuck with the prednisone.
If you have problems, you could talk to your rheumatologist to consider a shorter course of prednisone to try to quash the worse of the inflammation and then go to methotrexate or one of the new biologics if your insurance will approve it to help you taper more quickly. It's possible it may not spike your blood sugar so severely. It didn't for my dad.
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Yes. Its going to be a wild ride. If you can bear the pain then try to stay off steroids. They can create or enhance so many other things. But the largest percentage started using them for PMR pain and inflammation because its about the only thing that works. So you say do I want a life or not. Diet helps many. But sounds like you work on that. Methotrexate is an immune blocker. works on RA and can reduce cancer cells. Many try it as a means to taper off steroids. But it doesnt help with PMR. Newer biologics like Kevzara and Actemra reduce inflammation by blocking the IL-6. IL-6 has been shown to be active in PMR. If you can stand the pain maybe add one of those to the mix. I am sure someone has better information. good luck.