PMR and Methotrexate

This seems like a high initial dose and a very fast taper to me. I have had PMR for 15 mos. My taper was: 20 for 3 weeks, 15 for 4 weeks, 12.5 for 4 weeks, 10 for 4 weeks. Below 10 I have had 3 flare-ups and have not been able to keep to the schedule of 1 mg/month drop. I am at 8 mg and my rheumatologist thinks I have been on prednisone too long at higher doses and wants to add methotrexate. I am resisting because of the side effects of methotrexate and uncertainty about whether it will control symptoms and I'll just be on another toxic drug. I have been self-monitoring for side effects of prednisone, checking my blood pressure, blood sugar and heart rhythm. I had my eyes checked for glaucoma and cataracts. No real problems. I asked for a DEXA scan for my bones and we will do that. If all these checks for side effects don't turn up anything I will push for staying on just prednisone for a little longer. My rheumatologist would be much more comfortable if I could get to 5 mg. I don't know your health history and your doctor may have valid reasons to get you off prednisone faster. I do not have have significant health problems other than PMR. I'm 72 yo.

Hello @mbbs, Welcome to Connect. I see that @linda7 has shared her thoughts and experience with you. You will notice that we moved your post into an existing discussion here so that you can meet and learn what others have shared about Methotrexate and PMR.
-- PMR and Methotrexate:
https://connect.mayoclinic.org/discussion/pmr-and-methotrexate/
I'm not a doctor but normally only people suspected of having PMR and Giant Cell Arteritis (GCA) are started on high doses of prednisone. Also 10mg a month taper seems to be a big jump. Does your doctor suspect you have GCA or another condition as well as PMR?

Thank you for your input. I started out my prednisone at 15mg - didn't help at all. My doctor jumped it to 40mg. After about 2 months, my blood PMR test (CRP, QUANT and ESR-SEDRATE) reflected normal. Started the decrease by 10mg per month - now I'm stuck at 20mg with my symptoms returning. I'm 62 years old and do not have any major health problems. Everything that I have read, and your comment confirms, it seems like an aggressive taper. I also do not want to be on another toxic drug. Yet if there is a plan that has been successful to get this into remission and retain that state, I'm all ears. This is miserable.

Many people, myself included, have modified their diet. I have eliminated sugar and carbs. I have also incorporated swimming into my exercise. I really believe what we fuel our bodies with has an incredible impact.
I started Prednisone at 15mg in late August and started to taper in September to 12.5 and I’ll find out today whether I taper down to 10mg for another month. My ESR and C-reactor have come down to within range.
Good luck to all of us!

Hi all,
New to post. Had PMR in my 50’s and did well on conventional treatment. Had been off prednisone for 6 years with no pain issues… I guess I was a lucky one. But fast forward to now: after the year on prednisone I developed mild glaucoma, hypertension, and osteopenia (all which could have occurred without the pred, but probably accelerated with it). So, now I’m in my 60’s and PMR is back and prednisone is off the table. I will be starting methotrexate in a few weeks (after falling and fracturing my wrist, can’t start anything until healed). I heard it takes a few months to feel pain relief. I’m nervous but don’t really have any other option. Hope to hear from some who have had success with methotrexate only for pain management ( my goal is to move the needle from 8/10 in the morning to 4/10… ).

Welcome @christinetoo, Sorry to hear of the prednisone is off the table. I had 6 years between by first and second occurrence of PMR also but used prednisone for both. I will be 80 in a few months and have osteopenia and hypertension also. I made some lifestyle changes the second time around that helped me including exercising more and eating healthier. I eliminated fast foods, most processed foods and tried to eliminate sugar but I still have a ways to go with that.

You might also find these two discussions helpful:
-- Alternative to Prednisone for Treating PMR?: https://connect.mayoclinic.org/discussion/alternative-to-prednisone/
-- PMR: Are there treatment alternatives to Prednisone?: https://connect.mayoclinic.org/discussion/alternatives-to-prednisone/.

It sounds like you might already be keeping a daily log for pain levels. Have you made any lifestyle changes to help manage the pain?

“Movement is medicine”… learned that first time around the hard way. Hurt to move so I didn’t… until I couldn’t. Had to do PT to get back range of motion after I was off meds. Now I don’t let myself sit too long and slowly, very slowly, stretch in the am until I can move more freely. Has made this round tolerable for now.

I'm interested in hearing people's experiences with methotrexate as a steroid-sparing medication. My rheumatologist has pushed me to add methotrexate because I have been on prednisone over a year and a half and failed to successfully taper below 8 mg 4 times. Were you able to get off prednisone completely or just go to a lower dose by adding the methotrexate? Did you get off prednisone and remain on methotrexate? If so, how well did it control symptoms of PMR? Did you have any serious side effects? At my next MD visit in 2 months I agreed to add the methotrexate if my labs are OK and allow me to do it.

Have any of you inquired about low-dose naltrexone? I suggested it to my PCP, who had never heard of it. He looked up naltrexone and the lowest dose in his formulary was 8 mg, which combined with another drug for weight loss. I asked for a prescription for 4.5mg but he wasn't ready to do that. Bummer.

I am approaching my 2 year anniversary of being on Prednisone and am down to 3 mg. We added MTX almost immediately and I heartily endorse it. Not only has it allowed me to taper more quickly but the number and severity of a few flares have been significantly reduced. Most of the negative stories you hear about MTX are from gastro problems which are completely eliminated if you self inject once a week. My only side effect is a bit of fatigue for 24 hours after the injection which you can simply plan around in your schedule. Good luck!