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PMR and Methotrexate

Polymyalgia Rheumatica (PMR) | Last Active: Nov 27 11:03am | Replies (231)
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@tuckerp

I have seen lots of posts where MTX did not work. Its an RA drug being used to treat inflammation. RA drugs are a lot more plentiful. There are newer biologics that target the IL-6 receptor. They have shown IL-6 to be elevated in PMR patients. Actemra is designed to treat GCA as well. Kevzara is the PMR drug. I have also seen where these drugs including MTX can take 8 to 12 weeks to start working. But keep in mind all these inflammation drugs are designed to keep your CRP down while trying to taper. They do nothing for restarting your cortisol. Below about 5mg of prednisone is going to still require a very slow taper and restarting your adrenal glands.

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Replies to "I have seen lots of posts where MTX did not work. Its an RA drug being..."
ill | @ill | Oct 25 12:10pm

Thanks for your response.

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DadCue | @dadcue | Oct 25 5:15pm

In my opinion, prednisone perpetuates PMR after the adrenals are suppressed. I wonder how many people understand this or am I the only crazy person?

PMR is basically a condition of unregulated inflammation. A normal amount of cortisol isn't enough to get the inflammation under control. It isn't a shortage of cortisol though. The problem seems to be an excess of the IL-6 cytokine.

When we take higher doses of prednisone it replaces cortisol. We feel better because the inflammation is regulated by prednisone. However, when we attempt to taper off prednisone, we are confronted with prednisone induced adrenal insufficiency and a low cortisol level.

Adrenal insufficiency is an entirely new condition that mimics PMR. The treatment for adrenal insufficiency is to take more prednisone. We believe it is a PMR flare instead of adrenal insufficiency pain because of the response to more prednisone

This is the only way I can explain how Actemra worked so well for me. It is my belief that Actemra targeted the problem of excess levels of IL-6 and didn't suppress my adrenal function. After my cortisol level normalized, I could stop taking prednisone.

Now PMR is under control because the-pro inflammatory effects of L-6 are blocked. I don't need prednisone anymore.
https://www.sciencedirect.com/science/article/pii/S1043466621003318#:~:text=IL%2D6%20plays%20a%20major,%2D1%20and%20TNF%2D%CE%B1.
PMR is still treated as long as I continue to take Actemra. I don't know if and when I will be able to stop Actemra. My rheumatologist has never said I was "cured." About all that is said is that I'm "better" being off Prednisone.

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