Methotrexate vs Prednisone

Posted by smoore6480 @smoore6480, Aug 21 6:49pm

I have decided after researching and discussing with my Dr to ween off Prednisone while switching to methotrexate. I do not like how prednisone makes me feel and we both agree the long term use of methotrexate with proper monitoring is a better health choice.
Also tapering on prednisone can be difficult and frustrating once you get to 5 mg.
Anyone else have experience with doing this?

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

John, Volunteer Mentor | @johnbishop | Aug 21 7:18pm

Hello @smoore6480, I think there are quite a few members who have asked that question and have some experience. You might find the following discussion helpful on the same topic.
-- Methotrexate to wean off long term Prednisone for PMR: https://connect.mayoclinic.org/discussion/methotrexate-to-wean-off-long-term-prednisone-for-pmr/

Also, you might want to scan through the other discussions on methotrexate and prednisone to see if there are other discussions you might want to view. Here's a link to the discussions and comments: https://connect.mayoclinic.org/search/discussions/?search=Methotrexate%20or%20Prednisone

tuckerp | @tuckerp | Aug 21 8:12pm

Here are some of the problems I have heard. Just my opinion. MTX is drug that has been used to treat RA. It works on inflammation. It can also take 6-8wks to start working. Some have found it helpful in preventing the inflammation while trying to taper off prednisone. Many have said it doesnt work to stop the PMR. This drugs main focus is to prevent inflammation from returning while trying to taper. But it doesnt do anything for your cortisol production. You will still have to try and taper off prednisone and may still have a prednisone flare. Once you have tapered off prednisone the goal is to stop MTX. I have noticed Dr are leaving the patient on for maybe a year after just to prevent any flares. The newer biologics are aimed more at PMR than MTX. Kevzara and Actemra. They inhibit the IL-6 marker which has been shown to be active in PMR. Good luck.

jeansg | @jeansg | Aug 22 12:27pm

I was put on Hydroxychloroquine and Prednisone for PMR. Was feeling better but now that I’m tapered to 2.5 mg my pain has increased. Saw rheumatologist and he said labs showed my platelet CRP number had increased significantly indicating the hydroxychloroquine wasn’t working. He’s recommended I start taking Imuran. Wondering if anyone has taken Imuran and if so what your experience is?

DadCue | @dadcue | Aug 22 2:09pm

I think methotrexate (MTX) is a good medication to try. It is probably the most widely used Disease-Modifying Anti-Rheumatic Drugs (DMARDs) in rheumatology. MTX has anti inflammatory and immunosuppressant effects.

I took MTX for more than a year. I eventually stopped MTX contrary to my rheumatologist's wishes. It wasn't an immediate side effect but I was getting progressively more nauseated and my liver enzymes were increasing the longer I was on MTX. I had to admit MTX was helping me reduce my Prednisone dose so that was what my rheumtologist pointed to as evidence that MTX was working.

MTX is recommended for relapsing PMR but research is lacking about how effective it is for PMR. We can thank people with RA for all the DMARDs that are shown to be "disease modifying" for RA. I'm not so sure any DMARD is disease modifying for PMR because we don't seem to experience the inflammatory damage that people with RA and other autoimmune disorders experience.

The following link discusses the efficacy of MTX for PMR.
https://pubmed.ncbi.nlm.nih.gov/32043726/#:~:text=Six%20months%20after%20MTX%20initiation,six%20due%20to%20adverse%20effects.
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There are conventional DMARDs and biologic DMARDs. You never know what will work the best for you unless you try something to see what works for you.

The following link is a good summary of DMARDs in general.
https://versusarthritis.org/about-arthritis/treatments/drugs/disease-modifying-anti-rheumatic-drugs-dmards/
I don't think there is a conventional DMARD that works well for everyone with PMR. On the list of DMARDs, I have experienced four of the conventional and 2 of the biologic DMARDs. It took me 12 years to get off Prednisone but hopefully you will find something that works for you sooner than I did.

A biologic DMARD was eventually used to treat my case of PMR. Apparently trying MTX was a prerequisite for getting Actemra (tocilizumab) approved for me.

The goal should be "sustained remission" of PMR. However, I agree with you that " long term use of methotrexate with proper monitoring is a better health choice" than long term prednisone

prestol | @prestol | Aug 23 10:42am

In reply to @jeansg "I was put on Hydroxychloroquine and Prednisone for PMR. Was feeling better but now that I’m..." + (show)

@jeansg: I took Imuran for several years to try to get my Crohn’s under control, over ten years ago. I eventually needed to add a biologic. But it did not have any side effects and was easy to tolerate and discontinue. I have not heard of it being used for PMR.

jeansg | @jeansg | Aug 23 11:12am

In reply to @prestol "@jeansg: I took Imuran for several years to try to get my Crohn’s under control, over..." + (show)

Thanks for that info. I”m not able to take Methotrexate due to a cancer dx I have. So now that the hydroxychloride isn’t working he’s recommending the Imuran.