My impression is that methotrexate is viewed as being much less effective for PMR than prednisone by doctors and patients. It also has some bad side effects. When I decreased prednisone below 5 mg. I developed severe back pain and was referred to a pain clinic. The doctor there told me that he has seen a number of PMR patients in my situation, that once the PMR symptoms are reduced that old problems recur and new problems arise. His impression was that many patients try adding DMARD's (methotrexate) and biologics (Kevzara) but they end up back relying on prednisone due to the other drugs either not working well enough or having too many side effects. That has been the case for me so far but the experiment continues.

Tons of bad side-effects. Look it up. My doctor refuses to prescribe it.

Interesting! I wonder why. I’ve only had good luck with it.

Methotrexate has been around for decades and is relatively safe or doctors would not be prescribing it. The idea is to get off the steroids which have a multiplicity of issues long term. The Methotrexate is not meant (in so far as I understand) for long term. One needs monthly lab work to monitor liver functions tests in particular. Patients have rights. Your doctor should be explaining the reasoning behind not prescribing it for you. Perhaps you have a co-morbidity? But do get your doctor to explain. What will work for one person won’t necessarily work for someone else (as in the above post). It is about quality of life. Risk/benefit of any drug be it long term or short. I wish you well.

One new study at 25mg methotrexate showed that it does nothing for PMR. https://acrabstracts.org/abstract/results-of-a-one-year-randomized-double-blind-placebo-controlled-trial-with-methotrexate-25mg-per-week-for-recently-diagnosed-polymyalgia-rheumatica/