Kevzara or Methotrexate

Good morning, I am new to this site. PMR diagnosed 11/2025, started on 40mh Pred for 5 days. Worked wonders. I could not even dress myself. Fast forward to today. Tapered to 13mg now, but pain levels are 5 out of 10 in the morning and evening. Tapering 1mg every two weeks. Rheumatologist is recommending methotrexate. My question is, is this too soon to add the Metho? Should I go with a slower taper for a a bit?
I can function after a couple hours in the AM, with pain levels around a 2, but only for a few hours.

Thank you
Warren

For me --- it got ridiculous to tell me to taper off Prednisone as quickly as possible while also telling me to taper off Prednisone slowly. It didn't really matter how slowly or quickly I tapered because the result was always the same --- I relapsed.

I was on Prednisone for 12 years when a biologic (Actemra) was tried and then I could taper off Prednisone relatively fast. Splitting my Prednisone dose helped immensely at one stage but I didn't do that for the entire 12 years.

There were some extenuating factors but one of the reasons why a biologic was approved for me was because methotrexate and other options had all failed to get me off Prednisone. I wasn't sure which was more important --- to treat PMR or to get me off "long term" Prednisone. By that time, I was willing to try almost anything which would allow me to taper off prednisone.

At the time, I wasn't even sure if I still had PMR because the pain wasn't like my original PMR symptoms. In retrospect, I wish a biologic was tried sooner rather than later. Getting off Prednisone allowed me to begin to unravel the mystery of what pain PMR caused from what pain other conditions caused.

Know your lab numbers. It is time for better symptoms control so discuss options like bumping prednisone for a few weeks while waiting for Methotrexate to work. Actemra is a good option especially if your IL-6
can be checked and is elevated on prednisone. Ask about Dexascan if you
require long term prednisone. Systemic inflammation can raise our cardiovascular risk so reevaluate options with your doctors. The Mediterranean diet is considered to be anti-inflammatory.

I would suggest keeping a Pain Log - to help you and your Rheumy see the cycles of pain to help guide treatment. Since your pain level changes during the day you might want to log a few times a day. I would also suggest logging the prednisone levels. I started including my inflammation lab levels in my timeline to help me see how the prednisone levels influenced the labs. I come from a data analysis background and needed to record and review this information. Recalling the pain levels and changes became too much for me to recall successfully.
My Rheumy allows me a great deal of latitude when tapering, etc. She gives me guidelines I must follow. As long as I log and follow the basic guidelines I can choose when to taper, go back up, or stay level on my prednisone. Each body is different and we all respond to prednisone differently. I hope you are successful in your tapering efforts.

Hi and thank you, I do keep a daily log of pain level and dosage. I am splitting my dosage, 6AM and 6PM. My understanding is the pred stays in your system 16-22 hours. It's half life is about 5 hours. So presently I do 9mg in the AM and 4mg in the PM. My Rheumy is fairly stringent and doesn't really understand that each patient is different. One rule may not fit all.

@76ttop
I'm fairly new to this PMR life but I've noticed a few things. Few of us present with the so called classic symptoms which makes diagnosis difficult. Our PMR seems to react to different doses of prednisone. It can be difficult to describe the pain we're feeling. Doctors don't understand all the symptoms. Whether that's because some of us have more than one thing going on or because it affects each of us different, who knows. Doctors don't understand why 10mg prednisone works for some but it takes 40mg for others. Doctors definitely do not understand the pain levels we feel. I can't explain why at times it's difficult to even lift my cup of coffee or why I can't hold my phone long enough to finish reading a news article. I don't blame my doctor because my symptoms, pain and prednisone reaction are difficult to understand. I'm grateful that he's trying and that he's concerned with the known side effects of prednisone. I feel them. PMR is not a high profile disorder. Pharmaceuticals are not looking for a magic cure that will make them a fortune. As I'm writing this I can feel the pain building up in my neck and shoulders and I don't understand it. I'm fairly certain that I have PMR plus something else. Only time will tell.

I'm in the same boat. Diagnosed october 2025, started on 15mg, went up to 25mg. Tapering 1mg every 7-10 days. I was doing well, but went to 14mg the other day and I'm having pain, can't walk my 2.5 miles now without it feeling like I have 20 pound weights on my legs and someone is pushing me back with every step forward. I was going to ask about kevzara, but I read you should be under 10mg before starting that. I'll be following you to see how it goes! Good luck to you.

@mech

There is no requirement to be under 10 mg of Prednisone before starting Kevzara. I think 10 mg is roughly the dose that people often begin to experience more difficulty with tapering their Prednisone dose lower. It is hard to say why this happens. It could be withdrawal symptoms or increased activity of PMR symptoms. No two people are the same. I don't think having difficulty at 14 mg would be too unusual. Tapering by 1 mg every 7-10 days might be too fast though.

@dadcue thank you! My husband and I just talked about going to 2 weeks and see how that goes. My rheumy was the one who said 7 days, but I think it's too soon.

Hello @76ttop,

I combined your discussion with another discussion of the same title:

"Kevzara or Methotrexate"
- https://connect.mayoclinic.org/discussion/kevzara-methotrexate/

Here, you can meet @kass8174, @tweetypie13, and @tuckerp as well.