Methotrexate works for some with PMR but not many get a clear benefit from it. But some with PMR get good results from it. It is more effective for RA than PMR. Even for those, it works as a steroid sparer, reducing the steroid dose needed and it's rare if it can replace it. It's thought that when it works more effectively for PMR that the diagnosis may actually be late onset / elderly onset rheumatoid arthritis. (LORA / EORA).

Methotrexate did not work for me and after 18 months ended up making me very ill. It effectively put me back 12 months in the tapering journey. I am now trying Hydroxchloroquine which seems to have a small positive impact if I keep the tapering rate slow. It is a much more benign medication in terms of side effects.

But from everything I have read on this forum, it really does seem that the biologics like Actemra / Kevzara are the steroid sparers that really work for most people with PMR. (Unfortunately, they aren't approved for PMR in my country. )

If you do decide to try methotrexate, make sure you start at a lower dose and increase from there. That helps your body adjust. And also ensure that the doctor puts in place a scheme of very regular blood tests, 4 - 6 weeks, and ask questions about anything that starts to look odd in the results. Any changes to white and red blood cell counts need a good answer from the professionals as they can indicate potential toxicity. That's on top of the usual issues to do with liver etc.

Edited to say that I'm now 3 and a bit years into his journey and tapering has always been difficult.