New Methotrexate Study in PMR

"Methotrexate is currently recommended by both international and local guidelines as the first-line steroid-sparing drug to consider in polymyalgia rheumatica. These recommendations acknowledge that the evidence to support this advice is of poor quality. "
The Australian Prescriber - an independent peer-reviewed journal providing critical commentary on drugs and therapeutics for health professionals.

Thank you for posting that study. At this week's doctor's appointment I asked about the possible later use of methotrexate if I have a second flare. My doctor was not keen and said we should take things step by step. That study, along with others I'd found earlier which show minimal if any benefit of methotrexate in reducing prednisone (along with a lot of possible detrimental effects), solidifies my intention to avoid methotrexate.

I asked my GP what he thought about Methotrexate for PMR and he just said " can't comment on the Rheumatology, I just deal with a lot of the severe infection side effects from taking it" that was enough for me. My Rheumatologist is still pressuring me to take Methotrexate or Leflunomide despite the fact that Plaqunil has been working for me, without the awful side effects. She also completely denied my bad experience of taking the drug, told me it was all in my head !! I suspect this type of medical bullying and gaslighting is not uncommon when Rheumatologists are dealing with 'frail old ladies'. Thank you for posting this, it validates my experience.

This study only had 64 patients, not a lot to go on. I'm curious how many are patients are included in all the studies combined? And how does this compare to the other meds? They all have issues. We just have to pick our poison.

My experience with methotrexate was horrible nausea at first but I was able to taper prednisone easily from 7.5 mg, where I had been stuck, to 5 mg. Then it elevated my liver enzymes and stopped helping the PMR so I got off it. I was recently seen by a doctor in a pain clinic because back and leg pain is arising as Kevzara decreases the shoulder and hip PMR symptoms. He said that he has seen a number of PMR patients for similar problems and he observed that people try the DMARDs like methotrexate and the biologics like Kevzara and they either don't work or work for awhile, but in the end patients have to go back to prednisone because it works consistently and/or they had too many side effects on the other drugs.

But then prednisone has side effects too. So there's no perfect answer.

Adding the bad health effects of methotrexate to the side effects of prednisone is not something I'm willing to do, especially as the purpose of using methotrexate is to lower the prednisone dose, and even that doesn't work for most people.

I’ve been on prednisone since end of march 2025 & methotrexate added. Rheumatologist wants me off pred sooner rather than later due to osteoporosis. So far tapering from 20 mgs to 6mgs has been uneventful (except for weight gain, & what my blood numbers will tell me next month!) I don’t feel anything w/methotrexate, tho what it’s doing to my body inside is probably another story!!
So this journey in 2025 is so new as I was always healthy (as lots of y'all have said!) Why are our bodies attacking ourselves is really worth investigating. Environmental? What we are eating? Breathing? I plan on continuing to exercise at my Y, walk outside (so medicinal!) & eat veganly ( if that’s a word!)
I have even gone to a therapist as I was so depressed when first diagnosed this year-I felt like a loser-ashamed. So practicing kindness, compassion & care to ONESELF is something I need to work on!
Thanks for letting me express my feelings!!!

I’m glad you mentioned being depressed. Going from completely healthy to this painful, debilitating condition has been a nightmare.
I’m tapering now at 4mg of prednisone an 20mg of methotrexate and I feel almost as bad as when I was first diagnosed. Just this am I could
not lift myself out of bed. (Extreme pain.)
Waiting to call Rumy.
Miss golfing, PB and just walking normal

Diagnosed March 2023, started at 20mg and weaned to 5mg with few side effects. Had relapse and bumped back to 10mg, weaned to 3mg and relapsed, bumped back to 5. Included methotrexate 1/1/25 at 10mg/week. Daily dosage at 1, ending 8/31. Best medicine was knowing recovery was impossible to plan for and expectations around a recovery timeline were wasted. Having annual bone scans. Been in the gym and doing free weights consistently for past 9 months with positive results in DXA scan from last week. No magic wands.

" All in your head" is not an appropriate response from a physician. I would look for a new primary who is more caring and concerned. There are still a few out there. I am an old gentleman and understand how older people are treated sometimes. Let's stopping thinking old and frail and just say we are tough old birds:)