Does Methotrexate relieve PMR symptoms?

There are some good videos by rheumatologists that discuss methotrexate that will ease your mind. Reading about the potential side effects worried me too. The drug is said to be the "gold standard" for PMR and rheumatoid arthritis. My doc prescribed Methotrexate and I've been taking it for 7 weeks. The first few weeks I was also on a month of prednisone taper--20mg-5mg. I went 4 days without prednisone but the pain and stiffness came back. Now as I move through my 7th week on methotrexate without prednisone, I am not as stiff and not feeling as much pain, so the mtx is "kicking in." But I was told to have patience because it can take up to 12 weeks for the full effect.
Most worrisome to me is the potential for kidney and liver issues, but close monitoring by your doctor with lab work will help identifiy any issues.
So far for me, the day I take the methotrexate, which is a Wednesday, I seem to feel irritable and a little more fatigued than usual and don't have much of an appetite the day I take it and then seem to slowly feel better as the week goes on.
I'm guessing that my doctor prescribed a standard dosage which was four methotrexate tablets at once one time a week the first two weeks and then 6 tablets at once, one time a week.

P.S. I forgot to mention that I was diagnosed with PMR this past March so have only been dealing with it for 5 months. Started with prednisone the first two months and then doc prescribed hydroxychoroquin along with the prednisone tapers. I got a bad itchy rash from that, so stopped taking. I've had to rely on a prednisone taper almost every month since diagnosed.

Methotrexate enabled me to finally come off of prednisone. I've had hair loss with it but increasing the folate and adding biotin have slowed the loss. More recently I've had some mild nausea on the day I take it but it passes within minutes. I'm starting to reduce the dosage so I expect that will go away too.
We all react differently to the meds but I would say it's worth a try. Long term prednisone is no joke.

I used Methotrexate for 9 months last year (weekly self injections). I was at 20mg of steroids when I started, and it seemed to be effective until I reduced to 10 mg at the 4 month mark. At that point I got stuck and had to repeatedly increase and decrease until I gave up and switched to a biologic (Tyenne). That move allowed me to taper down to my current 1 mg (very slowly hoping to get to zero). Neither drug has had any side effects worth mentioning. In retrospect, I wish I had gone the biologic route sooner. (My rheumatologist gave me the choice). I would be done by now. The only reason I didn't choose the biologic was that she said it was incredibly expensive without ever saying how much that was! My bad for not investigating. It does cost more but it's so worth it!!

Methotrexate works for some with PMR but not many get a clear benefit from it. But some with PMR get good results from it. It is more effective for RA than PMR. Even for those, it works as a steroid sparer, reducing the steroid dose needed and it's rare if it can replace it. It's thought that when it works more effectively for PMR that the diagnosis may actually be late onset / elderly onset rheumatoid arthritis. (LORA / EORA).

Methotrexate did not work for me and after 18 months ended up making me very ill. It effectively put me back 12 months in the tapering journey. I am now trying Hydroxchloroquine which seems to have a small positive impact if I keep the tapering rate slow. It is a much more benign medication in terms of side effects.

But from everything I have read on this forum, it really does seem that the biologics like Actemra / Kevzara are the steroid sparers that really work for most people with PMR. (Unfortunately, they aren't approved for PMR in my country. )

If you do decide to try methotrexate, make sure you start at a lower dose and increase from there. That helps your body adjust. And also ensure that the doctor puts in place a scheme of very regular blood tests, 4 - 6 weeks, and ask questions about anything that starts to look odd in the results. Any changes to white and red blood cell counts need a good answer from the professionals as they can indicate potential toxicity. That's on top of the usual issues to do with liver etc.

Edited to say that I'm now 3 and a bit years into his journey and tapering has always been difficult.

I have been on Methotrexate for 3 months and only noticed a little dizziness if I took it early evening so I take it right before bed.

@mmons
Interesting. Do you also take Prednisolone. What dose?
Regards.

@snudge

Yes, been on Prednisone the last 8 months varying from 30 mg to now at 12.5mg decreasing every 2 weeks. When insurance goes thru I will srart Kevzara.

I have had PMR for about 18 months. I tapered the prednisone from 15mg to 1mg in about 6 months and had mild stiffness. Then I had a week of serious physical exertion and the PMR faired up worse than it had ever been. My rheumatologist ramped the prednisone up to 20mg but I got very little relief. Then he reduced the prednisone down to 10mg and added the weekly 15mg of methotrexate. Within 2 days of the first dose, I was pain free. I'm tapering the prednisone every 30 days and am down to 8mg. I am physically very active and so far, this is working. I haven't discussed with my rheumatologist what the rest of the tapering is going to look like. Good luck to all.