Using methotrexate with PMR

I don't want to ruin my liver so I wouldn't even consider it, even if I could get it. No rheums available around here. Good for yours, someone who is up to date. Most aren't.

Thank you for this important information. My Doctor prescribed the Methotrexate for my PMR and I hesitated to use it due to concerning side effects. Now I realized it was right decision.

I have been taking Methotrexate since the beginning of October. I have had PMR for 7 years. I see no improvement with Meth. only feeling worse by the day. Right now I can't say anything good about it and intend to call my Rhem. to try and taper off it. I will take my chances with the Prednisone.

Prednisone also made me feel worse the longer I took it. For me, feeling worse on Prednisone was overwhelming fatigue caused by adrenal insufficiency and a low cortisol level. Feeling worse when I took methotrexate was the nausea and vomiting caused by elevated liver enzymes.

I didn't start to feel better until I got off Prednisone. The biologic I'm currently taking makes me feel better. It does cause some mild lab abnormalities including slightly elevated liver enzymes but nothing that causes any symptoms. Since I get a monthly infusion of the biologic, I no longer worry about taking Prednisone every day or the dose I need to take and how slow my taper should be.

I don't know how much Prednisone you take but being on it for 7 years has some potentially bad side effects. The side effects are likely treated with other medications with more potential side effects. I know people prefer the devil they know but Prednisone is still a devil.

I know how difficult these decisions are. I was on Prednisone for more that 12 years. I wouldn't wish that for anyone. I'm sorry methotrexate isn't working for you. I hope you can find something else that works so you so can get off Prednisone someday.

Thanks for your help. I'm 81 now and hate to start putting new meds into my system now. The question is do I go to high doses of prednisone and feel better and thus have a better quality of life that I have left?

I was diagnosed w/pmr in april, 2024 and prescribed 15 mg of prednisone. I was able to taper off to 10 mg with night and early morning pain. In october my rheumatologist put me on methotrexate to be able to taper off prednisone. So far, methotrexate has done nothing . About 2 weeks ago i was prescribed deflszacort 12 mg daily to get me off prednisone right away..no tapering because deflazacort is also a steroid. I still have the morning pain in shoulders only, but once i get better i can just stop the deflazacort. My rheumatologist also put me on 7mg alendronate sodium once a week, and 5 mg folic acid daily for my bones. I have tried and continue to take vit d3, calcium, and vitc. Will now add the b vitamins. Good luck to all

It is so fascinating to see how people react differently. I am 86 years old and have been on Prednisone for 10 years. When I was on 60mg I was bloated and overactive and had difficulty sleeping but that was a fairly short time 6 months. Once I was on lower Fision’s I was great. Still playing pickle ball, walking every day, bone density is good. Cholesterol within the norm. BUT I have a question.
I was on 5 mg and two days ago had a big flare up of my GCA. I jumped to 25 mg and today am doing fine.

MY QUESTION: how quickly can I go down? Can I go to 20mg tomorrow?? Stay a week then 15 mg etc… My Dr is of absolutely NO HELP.

"I was on 5 mg and two days ago had a big flare up of my GCA. I jumped to 25 mg and today am doing fine.

MY QUESTION: how quickly can I go down? Can I go to 20mg tomorrow?? Stay a week then 15 mg etc… My Dr is of absolutely NO HELP."
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You really need a medical specialist to answer this question. Don't be deceived by "feeling fine" after you increased your dose from 5 mg to 25 mg. People who are doing fine don't need to take prednisone to feel fine. I know how prednisone works. One of the side effects is a false sense of well being.

In my opinion, that is the trap people fall into ... myself included. I took prednisone whenever I didn't feel fine. I was doing a disservice to myself because there were better solutions than prednisone for some of my conditions.

As it turned out ... my case of PMR is now being treated with a biologic that works much better for me. I learned so much after I tapered off prednisone. Until then I had no idea what all prednisone was doing to me.

I do know that none of my problems were ever solved during my twelve years of being treated with "long term" prednisone for PMR. I try to differentiate between long term use of prednisone and short term of prednisone. Short term Prednisone use didn't seem to cause me any additional problems like long term use did.

Could you share some of your other solutions? I tried ACTEMRA and was allergic so I had to stop that and return to Prednisone. Would love to have another alternative.

Some of my problems had nothing to do with PMR but I treated everything with prednisone anyway. One example that illustrates this was an episode of excruciating lower back pain that caused buttock pain which radiated down my leg. I took 60 mg of Prednisone and the pain stopped. I have no regrets about taking that much Prednisone because the pain stopped. The pain was caused by severe lumbar spinal stenosis.

"Severe lumbar spinal stenosis causing radicular leg pain" means a significant narrowing of the spinal canal in the lower back, which is compressing the nerve roots and causing radiating pain down the leg, often described as a sharp, shooting sensation, due to the irritation of the nerves; this is commonly referred to as sciatica and is a classic symptom of lumbar spinal stenosis.
https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961#:~:text=Spinal%20stenosis%20in%20the%20lower,people%20also%20have%20back%20pain.
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"Piriformis syndrome" can be a symptom of PMR and can cause the same symptoms that spinal stenosis causes. I have been on PMR forums where the self proclaimed PMR experts said I should take prednisone because piriformis syndrome is a symptom of PMR. When prednisone relieves the pain it is easy to believe that the pain must have been caused by PMR. None of this was true.
https://pubmed.ncbi.nlm.nih.gov/31102324/
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My rheumatolgist explained my MRI results to me and showed me precisely what was really causing the pain. She said I shouldn't have taken so much prednisone because there were other options. Surgery was one of the options but I didn't like that option. We talked about other options but I kept telling her that prednisone relieved the pain. She finally told me that she was happy the pain was relieved but I still had severe spinal stenosis.

I continued to take prednisone for spinal stenosis but surgery is probably my best option according to several spine surgeons. I kept telling them I don't have that much pain anymore mostly because I have lost a lot of feeling in my legs. My legs continue to get weaker. One surgeon said it isn't about the pain anymore ... I could end up being paralyzed. The same surgeon said he didn't believe me that I didn't have any pain. I told him I had pain but prednisone always relieved the pain.