PMR and Methotrexate

Posted by paulinef @paulinef, Mar 15, 2018

I have been on prednisone for about a year and am finally down to a daily 7 mg dose. However, still feeling some stiffness and my rheumatologist has suggested a couple of times that I could could also go on Methotrexate. I'm reluctant to take yet another medication though so am wondering if anyone else has tried Methotrexate and if it helped lessen the PMR symptoms.

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@dadcue

There already is an alternate medication available for PMR patients.

Kevzara (Sarilumab) was recently FDA approved and currently is available in the USA for the treatment of PMR. Kevzara is an IL-6 receptor blocker just like Actemra. Kevzara studies were promising for PMR just like Actemra was for GCA.
https://www.news.sanofi.us/2023-03-01-Kevzara-R-sarilumab-approved-by-FDA-as-first-and-only-biologic-indicated-for-patients-with-polymyalgia-rheumatica
Kevzara probably won't be available in the UK anytime soon. Prednisone is still the only option and the best option in the UK. I was told my experience with Actemra to treat PMR wasn't relevant to the good people in the UK who have PMR only.

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Yes, I've watched the discussions with great interest. Though I do not have it...I have high hopes that PMR folks will get lasting comfort~!💞

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I just started taking MTX. On my third dose. It doesn’t seem to lessen pain from PMR. What is your experience? Does it take some time before MTX helps with pain? Thank you.

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@lindamallot

I just started taking MTX. On my third dose. It doesn’t seem to lessen pain from PMR. What is your experience? Does it take some time before MTX helps with pain? Thank you.

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My doc told me it takes months for MTX to build up in system and to really have an effect. I am in month 2 of MTX and am tapering down the prednisone. It is a very slow process. I am living with some pain but yes I think the MTX is helping.

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Has anyone found that methotrexate helps combined with prednisone for pmr?

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Hi @glyn, I moved your discussion and combined it with an existing discussion, titled:

- PMR & Methotrexate
https://connect.mayoclinic.org/discussion/pmr-and-methotrexate
I did this so you could meet members like @barracudacool, @ghila, @livingwithpmr, and @christopherc who are new to methotrexate or have been on it for some time. If you click the link above, you will find the new location of your post and you can also read through and participate with other members' experiences with PMR and methotrexate.

@glyn, If you are comfortable sharing, have you been prescribed methotrexate or are you just exploring new ideas?

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@glyn

Has anyone found that methotrexate helps combined with prednisone for pmr?

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I am in my 4th month on methotrexate. It was very effective at getting me to a lower prednisone dose. I was stuck at 8 mg prednisone for over a year, with multiple flare-ups when I tried to go lower. I easily dropped 1 mg/mo to 5 mg after the methotrexate was added. I hate the side effects, though, and it has caused other problems. The first three weeks on it I had severe nausea, headaches and fatigue. Now I mainly get nausea, mostly off and on for 48 hours after the weekly meth dose. I have had urinary tract infection symptoms since I got on it, but negative urinalysis. My doctor thinks I have a low level infection, my immune system is suppressed too much and he has lowered the meth dose from 12.5 to 10. I also have elevated liver enzymes, which the doctor hopes will go down on the lower dose. I've considered quitting the meth a few times.

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@glyn

Has anyone found that methotrexate helps combined with prednisone for pmr?

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It was a long time ago but MTX was helpful for reducing my prednisone dose.

I took MTX for about 12 months until my liver enzymes started to increase. Then the retching started. It was clear my body wasn't going to let me take MTX anymore.

My rheumatologist wanted me to give MTX a second chance. I think I developed an aversion to MTX. The second chance only lasted a few weeks.

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Oh no that sounds awful.So how’s your pmr now?

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@linda7

I am in my 4th month on methotrexate. It was very effective at getting me to a lower prednisone dose. I was stuck at 8 mg prednisone for over a year, with multiple flare-ups when I tried to go lower. I easily dropped 1 mg/mo to 5 mg after the methotrexate was added. I hate the side effects, though, and it has caused other problems. The first three weeks on it I had severe nausea, headaches and fatigue. Now I mainly get nausea, mostly off and on for 48 hours after the weekly meth dose. I have had urinary tract infection symptoms since I got on it, but negative urinalysis. My doctor thinks I have a low level infection, my immune system is suppressed too much and he has lowered the meth dose from 12.5 to 10. I also have elevated liver enzymes, which the doctor hopes will go down on the lower dose. I've considered quitting the meth a few times.

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How many mg of prednisone are you on & has decreased methotrexate dose helped with side effects?

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I'm at 5 mg prednisone. This is my first week on the lower dose of methotrexate and I think it takes awhile to get it out of your system. I haven't noticed a change yet and I don't get labs done for 3 months. My rheumatologist is a big proponent of methotrexate. I get the feeling that most of his caseload has rheumatoid arthritis and the meth works well for that. As far as PMR, I have minimal symptoms, none at 8, 7 and 6 mgs but now some at 5.

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