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Methotrexate to wean off long term Prednisone for PMR
Polymyalgia Rheumatica (PMR) | Last Active: Jun 18 6:31am | Replies (26)Comment receiving replies
Hi All,
I was diagnosed with PMR 12/2020. I was on only Prednisone for 9 mons, the referred to a Rhematologist who prescribed Hydroxychloroquine and Methotrexate. I was on 15 Ming of Prednisone, Hydroxychloroquine twice a days and methotrexate 25mg once a week.
I had life stressors in 2021 and a big one 2022(Brother killed MVA) which trigger the PMR. I continued all meds and in 2023 tapered off Prednisone by July 2023. Staying on Hydroxychloroquine and methotrexate. This was all pain free.
Late Dec and 1st wk of January 2024I got a virus (not COVID) which was cough, body aches, headache, lethargic. Last 2 wks. Then, the thigh and hip pain came back, along with hand/finger discomfort. ESR and CRP done and sedrate was 48 and CRP 25. Rheumatologist put me back on 10mg of Prednisone. Repeat markers 2/29 still high Esr(now 51) and CRP 24. Stay on same meds. Repeat markers 4/1/24, esr 28 and cRP 16.5. Repeat markers 5/1/24, ESr 22 and CRP 22.9, told to reduce Prednisone to 9mg. Had markers drawn today (6/10).
So, my question is what is the purpose of the hydroxychloroquine and methotrexate if it can can handle a little virus? I’ve been on these since Sept 2022.
Any advise? I don’t see my Rheumatologist into September.
Thanks you
Replies to "Hi All, I was diagnosed with PMR 12/2020. I was on only Prednisone for 9 mons,..."
I wouldnt think of your immune system as on or off - or shut down or not. I think of my RA drugs as a thermostat instead of an on/off switch. Your disease has your immune system temperature turned up too high and the drugs - like Methotrexate - are there to turn it down. But not all the way off because you need SOME ability to fight off infection, even if that ability is somewhat impaired.
So maybe your immune system in its current state couldn't fight off that virus but that means methotrexate and prednisone were working as intended
Make sense?
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Lots of discussion on this thread to MTX. Generally the idea is to shut down your immune system as much as possible to allow you to get off the steroids. I find it pretty interesting you were able to make off it without any pain. Hydroxychloroquine and Methotrexate are both RA type drugs to do just that shut down your immune. Doing that also leaves you susceptible to may types of infections, viruses, eye problems, etc. The goal is to get you off steroids. Provided you dont have anything else going on. Having one autoimmune disease seems to open the door. However many on here say they dont work for PMR. In your case they worked. The issue is usually tapering off of steroids that creates new inflammation and can restart the PMR. I would think your goal and your Dr's would be to get the PMR under control to get off prednisone and then discontinue the other drugs. Taking both drugs your body is not able to respond to any kind of an immune threat. Right now you need to get PMR under control. But these drugs dont necessarily prevent PMR. They have some newer drugs that may help. Kevzara and Actemra.