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Using methotrexate with PMR

Posted by smoshetti @smoshetti, 4 days ago

My husband, 72yo, was diagnosed with PMR in March of 2024. He had rather severe symptoms...couldn't get out of chair and pain in neck and shoulders and fatigue. He was prescribed prednisone and tapered to 1 mg over 3 months. At this point was pretty much symptom free. He has hypertrophic cardiomyopathy and saw his cardiologist who told him to stop any prednisone immediately and see a rheumatologist for alternate medication. Blood work for inflammation is elevated but not extreme. He is experiencing symptoms but not as limiting. Rheumatologist is prescribing him methotrexate 10 mg going to 15mg in 2 weeks. He's afraid to take this medication because of side effects yet wants to avoid getting GCA. Anyone have experience with methotrexate therapy for PMR?
Thank you!

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smoshetti | @smoshetti | 1 day ago
In reply to @rosemargaret "My cardiologist has no problem with me taking about 5 mg of Prednisone and I have..." + (show)
@rosemargaret

My cardiologist has no problem with me taking about 5 mg of Prednisone and I have Hypertrophic Obstructive Cardiomyopathy. Guess there's a different opinion for everyone.

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That's very interesting! Maybe we should get q second opinion! Thank you so much!!

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jenbillig | @jenbillig | 1 day ago
In reply to @notacopy "My rheumy told me that Prednisone works immediately (and it did!) and Methotrexate takes several weeks..." + (show)
@notacopy

My rheumy told me that Prednisone works immediately (and it did!) and Methotrexate takes several weeks to kick in.

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My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?

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3 replies
linda7 | @linda7 | 1 day ago
In reply to @jenbillig "My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?" + (show)
@jenbillig

My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?

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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.

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1 reply
jenbillig | @jenbillig | 23 hours ago
In reply to @linda7 "My impression is that methotrexate is viewed as being much less effective for PMR than prednisone..." + (show)
@linda7

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.

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That was very helpful abd makes me wary of using anything else but Prednisone which has been very very helpful to me.

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1 reply
linda7 | @linda7 | 22 hours ago
In reply to @jenbillig "That was very helpful abd makes me wary of using anything else but Prednisone which has..." + (show)
@jenbillig

That was very helpful abd makes me wary of using anything else but Prednisone which has been very very helpful to me.

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I had good reasons to try the other drugs. After 2 or more years of PMR I could not get below 7 to 7.5 mg of prednisone. The damage caused by prednisone is related to dose. Nobody knows for sure but a dose of 5mg or less is considered safer and has fewer side effects. It was appearing that I had a chronic case and might be on prednisone for a long time so I needed to try other options. Those other drugs have allowed me to drop a couple of mgs but I'm off them now. At that point I have no apparent side effects with prednisone. Each person is different.

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cheneveygc | @cheneveygc | 22 hours ago
In reply to @jenbillig "My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?" + (show)
@jenbillig

My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?

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

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notacopy | @notacopy | 22 hours ago
In reply to @jenbillig "My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?" + (show)
@jenbillig

My rheumatologist refuses to use Methotrexate ? Wonder why? He never gave me an explanation ?

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

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