Alternative to Prednisone for Treating PMR?

Mehtotrexate is not an alternative to prednisone. It can be used for polymyalgia rheumatica as a steroid sparer. So for some people having difficulty tapering, methotrexate may help alongside prednisone. Effectiveness data of methotrexate for PMR as a steroid sparer is questionable, and there are possible side-effects .

yes that’s my understanding as well. I’d be willing to try it in low doses if it helps reduce the steroid dosage even more.

Hi everyone, This is my fourth episode of PMR 1n 10 years - groan. For my last session in 2018 I had difficulties in weaning off prednisone and the methotrexate seemed to help. I've attached a graph which shows on the X axis 'time since onset' and the Y axis shows the values. It shows that each time I tried to decrease the prednisone I had an increase in pain. The medical text "UptoDate'" has this to say about using methotrexate to help reduce prednisone "Data from randomized controlled studies on the efficacy of MTX as a glucocorticoid-sparing agent are mixed, though generally favorable results have been reported with regard to cumulative glucocorticoid doses, relapse rates, and time to discontinuation of glucocorticoid treatment [42,43]. Interpretation of a negative controlled study on the use of concurrent MTX is limited by a high dropout rate [44]. These data, however, are limited by several factors including the small number of patients studied and by the relatively low doses of MTX used (in the range of 7.5 to 10 mg/week) compared with contemporary doses (in the range of 20 to 25 mg/week). Also, no study has demonstrated an actual reduction in glucocorticoid-related adverse events in MTX-treated patients compared with patients treated with glucocorticoids alone." For my present episode, I've started again on methotrexate to hopefully reduce the total time on steroids - keeping my fingers crossed! However, the methotrexate does require monitoring and frequent blood tests. Oh, and booze not allowed 🙁 Hope this helps.

Hi @guillamocan, Welcome to Connect. I've had 2 episodes of PMR since 2007 but have been in remission since 2018. I've only used prednisone for treatment but my taper off time the second time around was 1-1/2 years vs 3-1/2 years the first time around with PMR. I attribute a lot of this to lifestyle and diet changes after my first bout with PMR. Just curious if you have made any lifestyle or diet changes to see if they might help?

Hello John and thanks for the feedback. Yes, indeed lifestyle and diet changes are so important, actually essential. I already had a healthy lifestyle but I needed to be even more vigilant with my lifestyle as it was hampered by the limitation of activity (initially) and the effects from prednisone (with weight gain). One source of excellent advice was from Kate Gilbert's book "Polymyalgia Rheumatica and Giant Cell Arteritis"

I really like your chart. I also keep a daily pain journal but I have been on MTX from the point that I was at 20 mg and I have not experienced the dramatic swings in pain other than a few that were caused by specific actions like overusing an jig, reciprocating and circular saws over a short time period which caused my shoulder to scream, but only to a pain level of 4 and which disappeared after 3 days of Tylenol and no increase in Prednisone. I inject my MTX; wonder if others do. I am at 4 mgs but my body seems to be telling me not to push lower and to stay at this level a bit longer. My journey is only 9 months long so I shouldn't complain.

The graph is simple to make with an excel spread sheet. For my graph the headings for the various columns were 1) Days since onset 2) pain (peak) levels out of 10 3) prednisone (mg taken). 4) methotrexate (mg taken). In a more recent graph, I added a "T 1/2" column which represented the time to decrease to 50% of the peak pain level. I found that the graph was very useful to share with my physicians. For this recent episode, I started at 15 mg of prednisone, but had to increase to 25 mg to control the pain. At present, I'm at 15 mg with the weaning off process and I'm at 4 months since the onset. Taking 15 mg methotrexate pills. Since the main side effect of methotrexate (for me) is fatigue and drowsiness, I switched from a morning dose to the evening - works better. Hope your journey goes well.

Thank you for this informative site!
I have PMR since end of May. I am tapering down to 3 pills 2.5 a day.
Doctor wants me to prescribe RX for bone loss. I have read the side effects and I would rather have a fracture than these side effects. Your thoughts?

Thank you
mpm

Welcome @mpm! My PMR has been in remission for 5+ years now but I do have osteopenia and have wondered about preventing bone loss. There is another discussion you might find helpful on the topic here:
--- Prednisone and bone loss. I was diagnosed with PMR: https://connect.mayoclinic.org/discussion/prednisone-and-bone-loss-i-was-diagnosed-with-pmr/.

Tapering can be difficult if you try to taper off too fast. Here's a discussion that you might want to look at:
--- PMR Dosages and Managing Symptoms: https://connect.mayoclinic.org/discussion/pmr-dosages/.

Do you mind sharing what dosage of prednisone you took when you started PMR treatment?

Hi John - I am healthy 72 years old, PMR came on within 36 hours. Primary care doctor referred to a Rheumatologist. Dr stated I was classic book example and prescribed 2.5mg starting with 6 pills. I did receive some relief - After 14 days, I began 5 pills a day and the pain was limiting me with my daily routine. I called the DR, sent an email and after 13 days in pain Dr responded with, “I will prescribe 5mg this one time. You need to pick what bone RX to take" I had already replied with the test results stating once inflammation is lower, I would weigh the pros and cons of these RX's.
I decided to choose a new Rheumatologist. I did see new DR last Thursday, she ordered 10 blood test and reviewed all. I am waiting for results and what's next!
I believe in the medical profession yet I have to be an advocate for my health without adding new side effects!
Thank you-
mpm