PMR: Are there treatment alternatives to Prednisone?

There are plenty of alternatives to taking prednisone for PMR. The trick is finding something that actually works. I have tried methotrexate and leflunomide along with a variety of NSAIDS. However, you shouldn't really take NSAIDs and prednisone together. Some people get by with just an NSAID which some rheumatologists might say is preferable to prednisone. For me, the NSAIDs didn't help me very much.

From what I read, LDN and hydroxychloroquine works for some people. I don't have any experience with those medications.

You need to be aware that it may not be just PMR you are dealing with. It may be a combination of things or something else entirely. If it is inflammatory arthritis, maybe a TNF inhibitor like Humira might help. Humira wasn't particularly helpful for me.

I would say methotrexate worked but I wasn't able to taper off prednisone. I did get to a much lower dose of prednisone after about a year of methotrexate. By that time my liver enzymes were increasing and I didn't like retching every morning. My rheumatologist wanted me to keep taking methotrexate but I stopped it.

Leflunomide worked. I got off prednisone for a couple of days. Leflunomide stays in your system for months. Infections were a problem the whole time I was taking leflunomide along with prednisone. I got an infection on the day I stopped prednisone. I think my body was deficient of cortisol and didn't like not getting any prednisone that day. Let's just say I had a "pain crisis" and needed 60 mg of prednisone again. My rheumatologist told me to stop leflunomide because of infections caused by "too much immunosuppression." The emergency room doctors wanted me to take prednisone because of a low cortisol level.

The only thing that has worked for me as evidenced by being able to taper off prednisone completely was a biologic called Actemra (tocilizumab). It isn't FDA approved for PMR but it is approved for GCA. If you have RA then Actemra is approved for that too. My rheumatologist need to seek authorization to get Actemra approved for me. I still take Actemra for PMR. I guess that I still have PMR so I'm not cured but I don't have very much pain anymore.

I don't have RA but I have another kind of inflammatory arthritis along with uveitis. My ophtalmologist said Actemra is "not optimal treatment" for uveitis. Now my ophthalmologist says Actemra "seems to be working" for me. Your mileage may vary.

Dear ronhon, I did enjoy your comments and laughed out loud at a few of them. Keep up the humour and good attitude and All the best moving forward. Claude67

Please tell me more. I was just diagnosed. My Dr says prednisone is the only thing he prescribes. But I know coming off of it only causes a rebound and taking it does all kinds of awful stuff to the body. I just DO NOT want to take it. Tell me more about the alternative Ned you are taking, please. It’s the Naltrexzone I’m curious about. Does it have bad side effects? Would love to chat with you about this. I am sooooo in pain and unable to do hardly anything and that is NOT me. Thank you for a reply. Kathy

Just diagnosed with PMR. I absolutely do NOT want to start the cycle of endless prednisone. Does anyone have any positive results without the steroid? What I read here sounds like no one can ever fully get off of them. I don’t want osteoporosis or decreased bone density or weight gain. I would so appreciate from anyone who found another way to manage their pain and stiffness. Thank you.

Hi kathyjb, I have PMR and I’m not on prednisone, same as you I don’t want the side effects, my opinion they are serious. I want to try LDN but my GP can’t prescribe it on nhs, probably a private doctor would, meanwhile he has given me nefopam, not started it yet but will give it a try, it does not read as safe as LDN - Low Dose Naltrexone, this is not the same as Naltrexone higher dose.

There are anecdotal positive reports on using Low Dose Naltrexone (LDN) to mitigate PMR pain.

LDN appears have minimal side effects. (I'm not a doctor, so do your research to make sure.)

Here's a link to a 2014 journal paper describing LDN and possible mechanisms behind its pain relief.
https://link.springer.com/article/10.1007/s10067-014-2517-2
There is currently a thread on this Mayo website for PMR where someone has reported positive initial results in relieving PMR pain with LDN.
https://connect.mayoclinic.org/discussion/ldn-and-prednisone/
The following link has more general information, including a link to a video
https://www.lowdosenaltrexone.org/features.html
There are several books on LDN, including "The LDN Book, Vol I" and "The LDN Book, Vol II".

Kathy, I’m in the process of getting diagoned, so this is early for me. I was very active physically but now trying to figure out how to manage pain. I started at 40 mg of Prednisone, and now down to 5mg. Little inflammation and soreness in right shoulder but better today. I miss exercise but found movement in water helpful. I’m told Tai Chi is helpful and will start that on Monday. I tried light weights but pretty tough on joints. Will keep you posted in my search for quality of life. Claude67

I am 4 months into prednisone and one week into LDN. It is too early to tell about the effects. My hope is that LDN will allow me a faster taper off prednisone and then the LDN will maintain me until PMR decides to pack its bags and take off. My prednisone so far has gone from 20mg to 12 1/2 with no problems, but I know most folks slow down drastically after 10mg, and I guess that will be the test for me. I will post whatever results I find. Read about LDN, maybe also CBD (that got rid of my dermatitis). Good luck, Kathy.

LDN does seem to lower inflamation and IL6 in particular which seems to be the main transgressor in PMR. I know there are some other cytokines but I think the research is on going on that. MSM is supposed to down regulate IL6 also and from my experience it seems to. One drug I could do without (am seem stuck with) is the estrogen blocker, anastrozole. Some of its side effects are a lot like PMR and can be very confusing.

I am on Actemra also. Wonder drug!!!! After almost five years on prednisone, hydroxychloroquine, methotrexate and Leflunomide which all did not work, I have gone into remission with Actemra. PMR is a challenge. Best wishes for healing.