1. < Polymyalgia Rheumatica (PMR)

PMR and Methotrexate

Posted by paulinef @paulinef, Mar 15, 2018

I have been on prednisone for about a year and am finally down to a daily 7 mg dose. However, still feeling some stiffness and my rheumatologist has suggested a couple of times that I could could also go on Methotrexate. I'm reluctant to take yet another medication though so am wondering if anyone else has tried Methotrexate and if it helped lessen the PMR symptoms.

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

tuckerp | @tuckerp | Oct 25 6:20pm
In reply to @dadcue "In my opinion, prednisone perpetuates PMR after the adrenals are suppressed. I wonder how many people..." + (show)
@dadcue

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.

Jump to this post

"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?" I know not many understand it. Post after post blames the PMR but I think that the prednisone is mostly responsible. The PMR for me left me with hardly any side effects (that I know of). I think of all the autoimmunes to get this seems to have the better of the outcomes. But I am better being off prednisone.

REPLY
karo89135 | @karo89135 | Oct 28 11:23am
In reply to @johnbishop "Hello @pualinef, my first round with PMR it took my 3 years to finally get off..." + (show)
@johnbishop

Hello @pualinef, my first round with PMR it took my 3 years to finally get off of prednisone. The PMR came back about a year or so ago and I went back on a 20 mg dosage of prednisone which I started tapering off after a month or so. I have been off of prednisone for about 15 days now but I still have some joint pain and stiffness. I'm learning to live with it unless it gets worse. I have no experience with Methotrexate but did find a study that I think may provide some help to answer your question.

NIH - Methotrexate in polymyalgia rheumatica: preliminary results of an open, randomized study.
-- https://www.ncbi.nlm.nih.gov/pubmed/8730115

John

Jump to this post

Hi John,

I was also put on Methotrexate for possible RA and PMR. My understanding is Methotrexate is not recommended for PMR. Because of side effects, I was started on Kevzara which also had severe side effects…headaches and malaise. With second Covid in May, had serious PMR flare. I am done with any more speciality injections or Covid vaccines. Since then, I am very concerned GCA might be affecting my eyes as my TMJ locks and is extremely uncomfortable. I increased prednisone to 10 mg and am waiting for rheumatologist appointment next month.
Any ideas anyone?
Karo

REPLY
bfh3 | @bfh3 | Oct 29 1:13pm
In reply to @ill "I'm 75 y.o. male with pmr for 3 years with multiple relapses and dose increases. Started..." + (show)
@ill

I'm 75 y.o. male with pmr for 3 years with multiple relapses and dose increases. Started mtx 3 months ago at 10mg weekly then increased to 15mg weekly for last 2 months. Was on 7.5 mg of prednisone and got down to 4.5 after the 3 months. Pmr symptoms returned and crp elevated more each month. Rheumatologist said just stop mtx and increase prednisone to 10 mg. This worked but wondering if anyone else found no results from mtx?

Jump to this post

I was lucky with methotrexate. My rheum got me onto it after inflammation returned when I was down to about 2-3 mg prednisone daily, last February. At the moment, I'm off prednisone (tapered completely off almost 3 months ago) but still on 15 mg methotrexate weekly, which I take on Saturdays, 7.5 in am, 7.5 in pm. He said I should expect to stay on it for about another year, though.

REPLY
rl24 | @rl24 | Oct 30 8:50am

I have been on Methotrexte for about 3 months now and the results have been positive. My CRP and ESD are both now in normal range. I am hoping to reduce the prednisone (9mgs) soon.

REPLY
prestol | @prestol | Oct 30 10:04am

I also have been on Methotrexate for three months, taking 20 mg all in one dose at bedtime. About two weeks ago I started feeling a definite improvement in PMR pain level, although OA pain is very much still with me. My rheumatologist has me taking one mg folic acid every day, although my pharmacist says it should not be taken on the Methotrexate day. Does anyone have feedback on this?

REPLY
4 replies
ill | @ill | Oct 30 4:07pm
In reply to @prestol "I also have been on Methotrexate for three months, taking 20 mg all in one dose..." + (show)
@prestol

I also have been on Methotrexate for three months, taking 20 mg all in one dose at bedtime. About two weeks ago I started feeling a definite improvement in PMR pain level, although OA pain is very much still with me. My rheumatologist has me taking one mg folic acid every day, although my pharmacist says it should not be taken on the Methotrexate day. Does anyone have feedback on this?

Jump to this post

I take all my mtx on Saturday and my F. A. DAILY same as you per rheumatologist rx.

REPLY
gsm1 | @gsm1 | Oct 31 8:30am
In reply to @prestol "I also have been on Methotrexate for three months, taking 20 mg all in one dose..." + (show)
@prestol

I also have been on Methotrexate for three months, taking 20 mg all in one dose at bedtime. About two weeks ago I started feeling a definite improvement in PMR pain level, although OA pain is very much still with me. My rheumatologist has me taking one mg folic acid every day, although my pharmacist says it should not be taken on the Methotrexate day. Does anyone have feedback on this?

Jump to this post

I have been taking methotrexate for about 6 months and it greatly helped to reduce Prednisone from 15 to 5 .However my kidney markers were getting bad so my rummy had me stop the methotrexate and for now just slowly reduce my Prednisone 1mg monthly to see what happens. There are about 3 markers for kidney functions so be sure your doctor is checking.

REPLY
1 reply
prestol | @prestol | Oct 31 9:34am

Thanks for your replies. Yes, I get kidney and liver function checked regularly. So far so good, although my mild anemia is worse. As to the folic acid question, I called my rheumy and she explained that it is held only when high-dose MTX is used, as in chemotherapy. It is comforting to know that 15-20 mg, that most of us are on, is considered a low dose. She says 25 mg would be the max for inflammatory arthritis.

REPLY
Joanne Kearsey | @jojobarrk | Oct 31 10:47am
In reply to @prestol "I also have been on Methotrexate for three months, taking 20 mg all in one dose..." + (show)
@prestol

I also have been on Methotrexate for three months, taking 20 mg all in one dose at bedtime. About two weeks ago I started feeling a definite improvement in PMR pain level, although OA pain is very much still with me. My rheumatologist has me taking one mg folic acid every day, although my pharmacist says it should not be taken on the Methotrexate day. Does anyone have feedback on this?

Jump to this post

My doctor and pharmacist have my husband taking folic acid the first and second day after methotrexate.

REPLY
marilyncarkner | @marilyncarkner | Nov 1 5:55am

I am in year 5 of my PMR battle. Currently on 12.5 alternating to 10 daily of Pred.My Rheuny put me on Methlytrexate last May( mg 25 ) once a week. I really think it has helped . I t took a few months to kick in but now having usual senior osteo stiffness but not much more.

REPLY
1 reply
View MoreView Less
Please sign in or register to post a reply.