PMR and Methotrexate

Thanks for the tag @loribmt. @con123, I thought I would tag you in the discussion suggested by Lori so that you can learn what others have shared about PMR and methotrexate. Thank you for being an advocate for your husband for his PMR. It helps to have someone that understands what you are going through during PMR symptom management and flare ups. I thought you might like to read a little on some lifestyle changes you might be able to share with him to see if it will help manage his symptoms.

-- Polymyalgia Rheumatica Diet: Do's and Don'ts: https://www.healthline.com/health/polymyalgia-rheumatica-diet

One thing I would suggest if he is not already doing it is to keep a daily log of his level of aches/pain when waking up in the morning along with his dose of prednisone or methotrexate for the day. My rheumatologist made that suggest to me early on with my first time with PMR and it definitely helped when it came to tapering. He told me to listen to my body and only taper down when my pain level in the morning was acceptable which for me was a 1 or 2 level.

You might also want to scan through the list of other discussions on methotrexate if you have any questions you are trying to get answered - https://connect.mayoclinic.org/search/discussions/?search=Methotrexate

Thank you very much for the info. Knowledge is power! My husband responded very well to prednisone, and is currently taking 10mg per day on his third round. He always has a flare when he goes off it, so the dr. gave him methotrexate, but he has only taken one dose so far. Time will tell how he does on this, but I am hopeful.

Hi. As @dadcue mentioned above, I have had RA for 12 years. My onset was very hard and acute and my rheumy struggled with whether it might be PMR (since I was sero negative at the time). But she gave me Humira and I had some degree of relief in a week. For several years I was also on Methotrexate (MTX) because both Humira and Enbrel tend to be more effective together with MTX than either drug is alone.

MTX is all right I guess. There’s a period in the beginning to adapt to predictable GI upset. If you plan to take it, lay in genuine peppermint for tea and ginger ale with real ginger oil in it. But the longer term risk is that it will produce antibodies to Humira (but not Enbrel) . So I had to switch to Enbrel but my liver enzymes continued to increase. I changed from oral to injection for a year or so to bypass the GI effect. But ultimately i had to go off MTX so switched to infusions of Remicade. I like it much better because the dose can be adjusted unlike the prefilled pens.

I am pretty well managed. I have occasional flares. And they are sometimes severe enough my Rheumy gives me Prednisone - usually starting at 15-20 mg and tapering down. I’m one who has euphoria at that starting dose so try not to need it often.

I hope that is helpful. Happy too answer any questions.
And as @dadcue mentioned, my son had reactive arthritis in his 20’s - and it was gruesome until we got the diagnosis. Happy also to answer any questions about that.

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.

Thanks for following up. Knowing that this is a marathon not a sprint and there will be good days, bad days and extremely bad days, I have seen a small improvement and I'll take the win no matter how temporary and how small. Any day I can get out of bed and start my day and being able to function is a good day. Only one dose so far so probably not feeling full affect but the big side effect for me is the onset of sudden fatigue or non sustainable activity. But I'm retired so I can deal with that. Trying to swim but I pay the price even with swim noodles . A bit worried about my muscle mass. 1st follow up labs are next week and maybe I'll know more.

Had my second dose this weekend. Pain was more localized after meds targeting those joints that have degenerative arthritis. Little queasy the next morning but resolved itself with a couple of crackers. Fatigue not quite as bad. Right shoulder the worst.

3rd dose day. Took MTX last night. This morning was not quite as bad as the last 2 Sundays. Shoulder pain while still rhe worst, not quite as bad. Hip pain not bad at all. Knees and right hand achy. A bit of head ache and nausea that subsided pretty quickly but still wiped out. I'm considering a cortisone shot for right shoulder. Has anyone gone this route?

When first being diagnosed , orthopedic Dr gave me a cortisone shot in the shoulder. It did seem to help for about 2-3 days. But then right back to the pain. The Dr. told me we needed to find another solution because he could only give a couple of those shots without damaging the joint. But I see many use the shot for temporary treatment. It doesnt fix PMR.

I had cortisone shot in right shoulder for PMR pain while tapering off prednisone, only helped for a few days. Have been on Kevzara for two months now and tapering down preds 1 mg every two weeks from 5mg to zero as of three days ago. I experienced some pain and discomfort in both shoulders and sternum with each 1 mg reduction but I believe I’m going to be pred free. 🤞Next will be getting off 15 mg of methotrexate weekly. Haven’t noticed any side effects from the Kevzara yet.