New Methotrexate Study in PMR

"Methotrexate is currently recommended by both international and local guidelines as the first-line steroid-sparing drug to consider in polymyalgia rheumatica. These recommendations acknowledge that the evidence to support this advice is of poor quality. "
The Australian Prescriber - an independent peer-reviewed journal providing critical commentary on drugs and therapeutics for health professionals.

Thank you for posting that study. At this week's doctor's appointment I asked about the possible later use of methotrexate if I have a second flare. My doctor was not keen and said we should take things step by step. That study, along with others I'd found earlier which show minimal if any benefit of methotrexate in reducing prednisone (along with a lot of possible detrimental effects), solidifies my intention to avoid methotrexate.

I asked my GP what he thought about Methotrexate for PMR and he just said " can't comment on the Rheumatology, I just deal with a lot of the severe infection side effects from taking it" that was enough for me. My Rheumatologist is still pressuring me to take Methotrexate or Leflunomide despite the fact that Plaqunil has been working for me, without the awful side effects. She also completely denied my bad experience of taking the drug, told me it was all in my head !! I suspect this type of medical bullying and gaslighting is not uncommon when Rheumatologists are dealing with 'frail old ladies'. Thank you for posting this, it validates my experience.

This study only had 64 patients, not a lot to go on. I'm curious how many are patients are included in all the studies combined? And how does this compare to the other meds? They all have issues. We just have to pick our poison.

My experience with methotrexate was horrible nausea at first but I was able to taper prednisone easily from 7.5 mg, where I had been stuck, to 5 mg. Then it elevated my liver enzymes and stopped helping the PMR so I got off it. I was recently seen by a doctor in a pain clinic because back and leg pain is arising as Kevzara decreases the shoulder and hip PMR symptoms. He said that he has seen a number of PMR patients for similar problems and he observed that people try the DMARDs like methotrexate and the biologics like Kevzara and they either don't work or work for awhile, but in the end patients have to go back to prednisone because it works consistently and/or they had too many side effects on the other drugs.

But then prednisone has side effects too. So there's no perfect answer.

Adding the bad health effects of methotrexate to the side effects of prednisone is not something I'm willing to do, especially as the purpose of using methotrexate is to lower the prednisone dose, and even that doesn't work for most people.