Experience with Methotrexate?

Posted by abbeyc @abbeyc, Feb 14, 2022

Hello, I have been on 20 mg of Prednisone for about 2 months and at my next Rheumatologist check-up this week, my doctor is going to talk to me about the option to add Methotrexate on top of the Prednisone. Has anyone tried this? Any success? Any advise? Seems like another strong drug to have to worry about the side effects. Wondering if it's worth it.

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

@flymetothemoon

I have been dealing with PMR for 2 1/2 years. Tapered off Prednisone and got a flare up. Started back on 5, now down to 3 and not feeling great. My hands also are really hurting. Just got a second opinion from another Rheumatologist and I am going to stick with her. She clearly wants me off the Prednisone since it effects my blood sugars and bones. I will probably taper slowly off the 3 mg pred which doesn't seem to be helping, while on Methotrexate. Both Rheumatologists believe it is the lesser of the two evils, depending on those side effects. Just means more blood tests to monitor liver. Not easy and this pain from PMR is not something you can even describe. I take calcium pills, had Reclast infusion and stay active to protect my bones. Challenging times.

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After my second flare up of PMR my Rheumatologist put me on Methotrexate, 6 tabs 1 day a week. 95% of hand pain is gone & I’m feeling the best in months. Still on 15mg of prednisone daily. She also added Folic.

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@abbeyc

Thank you for sharing. Did any other negative side effects occur from the Methotrexate, like hair loss, since it's a chemo drug?

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My Rheumatologist said hair loss is nothing like when you are on chemotherapy. I lost mine in ‘88 from chemotherapy drugs for cancer. Not a big deal in my book. I lose strands from prednisone & methotrexate now. If I go bald again I can handle it. It eventually grows back. Good luck

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@marieirene

After my second flare up of PMR my Rheumatologist put me on Methotrexate, 6 tabs 1 day a week. 95% of hand pain is gone & I’m feeling the best in months. Still on 15mg of prednisone daily. She also added Folic.

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This is close to my recommended dosage. I am on Methotrexate 2.5mg 4 tabs a week (1 per day). I also take 15mg prednisone. What is your dosage on the Methotrexate?

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@wv54

I am currently on 2.5 mg of Methotrexate / 6 tablets 1 day a week -- I am also on 5 mg of Prednisone -- The RA doctor wants to eventually eliminate the Prednisone ---------- the RA doctor and my family doctor both stated it is very important to take a Folic Acid tablet every day -- I currently take 1 mg of Folic ------------- I have been on the Methotrexate since the 1st of January 2022 - so far - so good

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I am on the same dosage of Methotrexate and folic acid, and have been reducing prednisone by 1 mg each month. I am now down to 1 mg Prednisone (woohoo), from at least 10 mg daily for 18 months. Exercise is very important, but overdoing it is not advised, but my symptoms were very well controlled. I hiked and walked dogs 6 miles on Sunday and again on Monday, then spent 3 hours on Tuesday removing invasive species at forest preserve workday - bending, squatting, using loppers, etc. I joined this forum about an hour ago, because I am suffering today, LOL . Trying to find out appropriate level of activities.

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@avidhiker

I am on the same dosage of Methotrexate and folic acid, and have been reducing prednisone by 1 mg each month. I am now down to 1 mg Prednisone (woohoo), from at least 10 mg daily for 18 months. Exercise is very important, but overdoing it is not advised, but my symptoms were very well controlled. I hiked and walked dogs 6 miles on Sunday and again on Monday, then spent 3 hours on Tuesday removing invasive species at forest preserve workday - bending, squatting, using loppers, etc. I joined this forum about an hour ago, because I am suffering today, LOL . Trying to find out appropriate level of activities.

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Welcome @avidhiker, It sounds like you are on your way to remission from PMR. Daily activity is certainly a key factor but I think you may be feeling what a lot of us have learned about overdoing it - it can cause an increase of pain the next day. My rheumy told me I need to listen to my body when it comes to pain and activity.

You might find the following discussion helpful:
— PMR Dosages and Managing Symptoms
https://connect.mayoclinic.org/discussion/pmr-dosages/

I always keep a daily pain log along with the amount of prednisone I took that day. I hadn't thought about also recording activity for the day but in retrospect it might have been helpful. Do you keep a daily log of your pain level and dosage?

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@johnbishop

Welcome @avidhiker, It sounds like you are on your way to remission from PMR. Daily activity is certainly a key factor but I think you may be feeling what a lot of us have learned about overdoing it - it can cause an increase of pain the next day. My rheumy told me I need to listen to my body when it comes to pain and activity.

You might find the following discussion helpful:
— PMR Dosages and Managing Symptoms
https://connect.mayoclinic.org/discussion/pmr-dosages/

I always keep a daily pain log along with the amount of prednisone I took that day. I hadn't thought about also recording activity for the day but in retrospect it might have been helpful. Do you keep a daily log of your pain level and dosage?

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Hello John. Thanks for your reply. 1. I have tried a diary, to try to figure out role of foods, exercise, etc. on symptoms, but it always seemed to be so random so did not continue. 2. I do not adjust the amount of prednisone, and did not know it was an option. I have been steadily reducing prednisone by 1 mg every month, and hoping to be finished with it in a few weeks. My activity level is 'active' but this is the first time in a while that I did so much on three successive days. Lesson learned. Thanks for the link to the discussion. I will check it out.

What about pain? My pain-reliever of choice was Ibuprofen, but apparently that should not be taken with Methotrexate. The information recommends Tylenol, which I would rather not use for a variety of reasons. I just bundle up warm and try to stay comfortable.

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Most RA doctors have a protocol that they follow to "climb the ladder" on drugs to find what will have a positive effect. Each has side-effects. One ladder is:
NSAIDS
Prednisone
Methotrexate
Hydroxychloroquine
Biologics like Simponi Aria then Orencia

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I experienced anal fissures along with the other anal side effects. Had to come off of the drug.

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Methotrexate has been a blessing for me! I had a flare up & prednisone was back to 15mg daily with methotrexate. I felt 95% normal. No side effects. Today I’m
Back to 10mg daily prednisone. Hopefully I can handle it. I exercise almost daily, Pilates& walking. Try to keep moving. I need to do better with my eating habits. Good luck to all.

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In my last flare up I had swollen & painful hands. My markers were sky high. Got a shot & felt relief. She put me on methotrexate & I continue to take six 2.5 mg each Wednesday. Starting to taper prednisone to 10mg daily. I hope to get to the pain free stage without difficulty. I also take 1mg folic acid daily. I read where you shouldn’t take calcium tabs at same dosage time as prednisone so I don’t take them together.

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