1. < Polymyalgia Rheumatica (PMR)
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Does Methotrexate relieve PMR symptoms?

Posted by dvgreenw @dvgreenw, Jul 30 7:51pm

I have had PMR for 3.5 years. Highest dose of prednisone was 15 mg. Tappered to 3 mg and had a flare. Back to 10 mg. Same thing happened again. Tappered again from 10 mg. Same thing. Now I have been off prednisone for a month and I am stiff and my legs are weak. Dr has suggested methotrexate, but side effects sound scary. He wants me off prednisone. Someone have experience with that drug?

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kare1 | @kare1 | 1 day ago

I started prednisone end of 3/2025 (15mgs) then end of May started 15 mgs (6 pills) of methotrexate. Tapering pred was pretty good pains were relieved. At around 3.5 of pred pains came back (early winter this year) so bumped to 4mg for a month of Feb then slowly tapered. Fast forward to March where I began the alternating schedules after 3 weeks at 2mg w/no issues the pain started emerging. Here I am at the alternating of 1.5/2 mg schedule. I wake up groggy, bilateral hip pains which sitting does aggravate! I continue to walk most days 2+ miles-sometimes getting 2 miles in am & 2 miles in the pm and do ok. So as to methotrexate I’m not sure if it’s helping or not. I just don’t know about what methotrexate is doing besides messing w/lab numbers. Prednisone Early this year on 4 mgs & here it is August & at 1.5/2. That seems to me a very long taper!! Shouldn’t methotrexate have done a better job of helping me taper???Maybe I was too cautious in my tapering.
I’ll have virtual rheumatologist appt next week. We’ll “talk”& look at lab numbers. I want to wean off prednisone & methotrexate. Wonder if one can take fewer methotrexate tabs? I’m concerned w/the biologics & coverage. We hear next year our gov is fiddling w/medicare plan D coverages.
So, this isn’t much help w/methotrexate question. Metho does seem to interfere w/digestion/going to the bathroom often. 🙄which in the morning keeps me home till things settle down. Rheumatologist says that’s the metho.
Sorry for the morning rambling! Oy vey.

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terre | @terre | 1 day ago
In reply to @gmdb "Methotrexate works for some with PMR but not many get a clear benefit from it. But..." + (show)
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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.

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@gmdb be careful with the hydroxychloroquine it caused my retinas to deteriorate and had to have surgery. It’s the first warning in the paperwork.

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gmdb | @gmdb | 23 hours ago
In reply to @terre "@gmdb be careful with the hydroxychloroquine it caused my retinas to deteriorate and had to have..." + (show)
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@gmdb be careful with the hydroxychloroquine it caused my retinas to deteriorate and had to have surgery. It’s the first warning in the paperwork.

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@terre THanks. Such a terrible side effect. I hope the operation worked out well. How long had you been taking HCQ for? They say the risk emerges after 5 years of HCQ, but I've heard that it can happen much earlier.

I had my eyes tested when it was first prescribed, completely on my own initiative, as the doctor didn't mention it at all. And I keep the dose below at 5 mg per kg (2.2 lb) of lean body weight which is from the American Academy of Opthamologist guidelines. That is supposed to avoid the worst of the side effects.

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voll | @voll | 10 hours ago

I’ve been on it now for six months along with the prednisone and I’ve been reducing the prednisone monthly. Whether it works or not, I really cannot tell. However, when I had PMR 10 years ago, I was on prednisone only and I’m not sure I feel any difference.

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