PMR and Methotrexate

I’m pleased to hear you’re feeling well on the methotrexate. Some people cannot tolerate prednisone while for others, it’s a life saver. Fortunately we have other drugs that can give people their life back. PMR for me was the worst painful memories of my lifetime. I never want to suffer like that again. Be well.

Just for contrast about how one person can feel one way about something and another person can feel entirely different.

I felt like PMR was a "blessing" to me because of being previously diagnosed with other autoimmune conditions. The other conditions were "steroid responsive" so 60 mg of prednisone and a fast taper would be all I needed to achieve remission. I always had leftover prednisone from being treated for those other autoimmune conditions.

I was already a prednisone "junkie" before PMR was diagnosed because I put leftover prednisone to good use even though I didn't always have a doctor's blessing. I didn't hide anything because I admitted to self medicating.

When I told this to my rheumatologist, she was aghast and asked me why. I said that I didn't want to bother anyone! I was very happy that my rheumatologist would prescribe prednisone legitimately for PMR.

After taking prednisone for 10 years for PMR, I was having doubts about whether or not I still had PMR. I wanted off prednisone so badly but I couldn't taper off. I wrote a tactfully worded question to my rheumatologist about whether or not she only diagnosed PMR because I wanted prednisone.

I don't know how she felt but she seemed stern and reaffirmed that my diagnosis was PMR. She said she would not have prescribed prednisone if she didn't think I needed it.

I was just reviewing some of our correspondence that my rheumatolgist and I had in the past. I would refer to myself as a a prednisone junkie but an honest one. I just read what I wrote to my rhematologist 5 years ago. I wrote the following:

"I am wondering what you would recommend about the following: I am down to 7 mg prednisone in October and plan to decrease to 6 mg in November. Today, the problem is a sore neck, shoulders and extreme fatigue with ongoing lower back and hip pain. I am feeling progressively worse but not drastically worse, however, I doubt my wife would agree with that assessment. We will be going away and doing something fun during the last part of October and first part of November. I would like to feel as good as possible when we leave. I am sure that I will need some kind of anti-inflammatory because decreasing prednisone further isn't going to make me feel any better. We won't be leaving for a couple more weeks but I would like to feel as good as possible when we leave. In the past, I will confess to taking significantly higher doses of prednisone specifically for trips like this. Regardless of whether it was a good idea or not --- it worked."

I can't believe how stupid I was!

I’m certain that when she prescribed prednisone your CRP and SEDIMENTATION RATE blood values were high and you presented with shoulder and hip pain or multiple joints affected.

Yes ... they were high even when I was taking prednisone. I remember my rheumatologist remarking to me when I was on 30 mg of prednisone. She said my inflammation markers were still elevated on 30 mg and instructed me to bump it up to 35 mg. It took a long time for my inflammation markers to get within the normal range.

After Actemra was started, I was somewhat shocked that my inflammation markers were so low. I asked my rheumatologist if they were too low!

My C-Reactive Protein has been within acceptable limits, showing Prednisone is addressing the PMR. My sed rate is elevated but my immunoglobins are out of whack from Myeloma so this affects my test. Just started Methotrexate, 10 mg once per week while going down from 15 mg to 12.5 mg Prednisone to try to get me eventually to 5 mg. More aches and pains, lots of fatigue but I'm giving it time to see if the Methotrexate is effective.

I was diagnosed with pmr in December. 40mg of pred helped alleviate most of the symptoms. Then in February I was diagnosed with blood clots in my lungs and in particular a saddle pulmonary embolism. The hematologist thinks it was a combination of things causing this including the inflammation from pmr and long Covid. And the prednisone. Bad six months to be sure. I have been tested for lupus 5 times. Rheumatologist also concerned about long term use of prednisone and has started me on methotrexate at 10mg. At the same time continuing to take 30mg of prednisone. He has now offered to “accelerate” the MTX buildup by upping me to 20mg a week. Anyone done this. The side effects of MTX for me are dizziness and fatigue for two days but I can put up with that if it gets me off prednisone, or at least at lower doses, more quickly.

I have just gone on 10 mg. of methotrexate morning and evening once a week. Sure hope it will be effective. I guess it can take 6 - 8 weeks.

Hello- I was diagnosed with PMR 12/2021 by my Primary care provider. She started me on 15mg of Predisone daily and after 6 month reduced to 10mg. Sometime summer of 2022 taper to 7mg and stayed there until I was referred to a Rheumatologist, Sept 2022. He started me on Hydroxychloroquine 200 mg twice a day. Then in November 2022 he added Methotrexiate 20mg weekly, continued with 7mg of prednisone. Feb 2023 began to reduce Predisone by 1mg a week and now I’m off Pred and still on the other two. My ESR is high normal and CRP still elevated. The rheumatologist is not convinced I have PMR but Inflammatory Polyarthritis. I can tell you that I am not convinced that the other two meds are helping but I can say my pain score on the predensone (2mg) and the other two drugs was about a .5 out of 10. Now w/o Predisone for about 5 days it is at a 3. I do take extra strength Tylenol which helps.

I will continue with the hydroxycloraquine and methrotrexate but I’m not sure why I need both. If someone can shed some light on that subject, I would appreciate it.

Thanks!
Maj

Hi Maj @majryan61, It's good to learn as much as you can about the PMR condition. Mine is currently in remission but I've had two previous occurrences of PMR. Here are a couple of articles that might be helpful:

--- Diseases that mimic polymyalgia rheumatica (PMR):
https://www.medicalnewstoday.com/articles/diseases-that-mimic-polymyalgia-rheumatica
--- Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica: https://ard.bmj.com/content/early/2023/02/23/ard-2022-223429

I was diagnosed with PMR in April 2022 at age 78. I had a mild case of COVID in late Dec. 2021 and never felt like my normal self after that. I was fatigued, lost my appetite, lost weight, had a low-grade fever and night sweats. This lasted for about three months and then the muscle aches in my triceps, hamstrings began. I saw my PCP due to the aches, and she wanted more tests done. The next morning I could not get out of bed due to the pain. The pain felt like broken glass in all of my muscles. I was diagnosed with PMR in the emergency room. Like you, my diagnosis was changed by my rheumatologist about 5 months later to Inflammatory Polyarthritis. I have tapered the prednisone to 5 mg and am tapering by .5 mg every two weeks. I have been on hydroxychloroquine since the Inflammatory Polyarthritis diagnosis. I am getting my stamina back somewhat, and have aching whenever I am still for a short time, but it goes away when I move. The arthritis in my hands is my biggest issue right now. I have been to hand therapy and have found compression gloves worn at night help with swelling and agility of my fingers. I walk for at least 30 minutes every day and do regular exercises provided by physical therapy. It is hard to believe that I was so active and fit one year ago and now have to pace myself to maintain my stamina. The sun is finally shining in Northern California and I am hopeful. Best to you.