Using methotrexate with PMR

Posted by smoshetti @smoshetti, Jan 7 5:46am

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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@dadcue

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.

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Prednisone controls the inflammation and that is so important. Probably saved my eyesight and maybe even my life. Stroke possibly etc… so as much as it is imperfect as far as side effects it is still in my opinion the miracle drug that always me to live.

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@rosemargaret

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.

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I started Methotrexate end of December 2024, and my PMR symptoms are much better but still on 40 mg prednisone daily (no taper) as my inflammatory markers are still high. The Methotrexate side effects are unpleasant though. I was taking weekly folic acid, but have been switched to leucovorin 3-5 days a week depending on severity of side effects. But being able to walk is making me very happy.

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@sticksandbugs

I started Methotrexate end of December 2024, and my PMR symptoms are much better but still on 40 mg prednisone daily (no taper) as my inflammatory markers are still high. The Methotrexate side effects are unpleasant though. I was taking weekly folic acid, but have been switched to leucovorin 3-5 days a week depending on severity of side effects. But being able to walk is making me very happy.

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Saw Rheomatologist today. Going off Methotrexate as of today and back to a little higher Prednisone. Little did I realize until rereading my daily notes that I was gradually getting worse on Methotrexate....no visible side effects....but physically weaker and in more pain. I will be stopping the folic acid and going back to my B12 daily. Hoping to see fast improvement. Hoping to walk a little again!

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@rosemargaret

Saw Rheomatologist today. Going off Methotrexate as of today and back to a little higher Prednisone. Little did I realize until rereading my daily notes that I was gradually getting worse on Methotrexate....no visible side effects....but physically weaker and in more pain. I will be stopping the folic acid and going back to my B12 daily. Hoping to see fast improvement. Hoping to walk a little again!

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I hope you're feeling better very soon. I took folic acid (now leucovorin) and B12 at the same time, did your doctor say to stop the B12? I should ask about that.

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I was taking B12 and stopped it when I started Folic Acid. I just eliminated the Folic Acid when I stopped the Methotrexate on my own and went back to B12. Maybe I should have asked??

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@rosemargaret

I was taking B12 and stopped it when I started Folic Acid. I just eliminated the Folic Acid when I stopped the Methotrexate on my own and went back to B12. Maybe I should have asked??

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There is so much to keep up with! Who knows 🙂

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