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.