I was diagnosed with PMR in Jan 2022; started on 20 mg, and went on a taper of 2.5 mg a month until 10 mg, then 1 mg a month. I had a flare around 10 mg, moved back up to 11 for a few weeks and things quieted down, then got to 5-6 mg before another flare which presented mostly in my hands (which had not been previously affected). I had trouble bending my fingers and making a fist, along with a return of mild bi-lateral shoulder pain (though so hard to separate it from partial rotator cuff tears predating the PMR diagnosis. I was moved back up to 10 mg and started a new taper schedule going down by 1mg every two weeks but at 9 mg the hand issues returned. Now my rheumatologist is suggesting that I consider going on Methotrexate and I am concerned whether this is indicated at this point in the treatment.

Is anyone on Methotrexate? Once you are on it do you stay on it indefiniely or is it tapered off ideally as well?

Are the side effects of Methotrexate worse than long -term Prednisone?

Is it premature to consider getting more aggressive; put another way, is there any clear protocol on when moving to this drug is indicated?

I read that many on this forum have been tapering for well over a year and I am only 9 months in so wondering whether I just need to be patient?

Thanks to all who can shed light on this.