What's a good anti inflamation drug (not prednisone) for PMR?

Posted by girastancil @girastancil, Aug 20 5:36am

I'm currently on celebrex and want to ask if anyone uses something they may have had more success with. I understand celebrex is safer than ibupropen but have heard there are some "stronger" anti-inflam drugs as safe as celebrex. Please respond. thanks much

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

@girastancil, Hopefully other members with PMR who have used treatments other than prednisone can share their experience with you. The only alternatives I've read about are Methotrexate, Leflunomide and Tocilizumab. Here are a couple of articles on alternatives. The first one is a free publication, the second is an abstract and one you have to buy if you want the full read.

"There is a lack of definitive evidence for steroid-sparing drugs in polymyalgia rheumatica. Methotrexate is typically used for relapsing disease. Leflunomide and tocilizumab are being investigated, but further research is needed."
— Prescribing for polymyalgia rheumatica: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828929/

"Conclusions:
Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted."
— Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica: https://journals.lww.com/jaanp/Abstract/9900/Alternatives_to_glucocorticoid_monotherapy_in_the.39.aspx

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@johnbishop

@girastancil, Hopefully other members with PMR who have used treatments other than prednisone can share their experience with you. The only alternatives I've read about are Methotrexate, Leflunomide and Tocilizumab. Here are a couple of articles on alternatives. The first one is a free publication, the second is an abstract and one you have to buy if you want the full read.

"There is a lack of definitive evidence for steroid-sparing drugs in polymyalgia rheumatica. Methotrexate is typically used for relapsing disease. Leflunomide and tocilizumab are being investigated, but further research is needed."
— Prescribing for polymyalgia rheumatica: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828929/

"Conclusions:
Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted."
— Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica: https://journals.lww.com/jaanp/Abstract/9900/Alternatives_to_glucocorticoid_monotherapy_in_the.39.aspx

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thank you very much – which of these would you suggest by the way. I'm thinking of the tocilizumab you noted. thanks again

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@girastancil

thank you very much – which of these would you suggest by the way. I'm thinking of the tocilizumab you noted. thanks again

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@girastancil, I don't have any experience with either but @dadcue started a discussion on tocilizumab and others shared their experience which may be helpful.

— Actemra (Tocilizumab) to treat PMR??: https://connect.mayoclinic.org/discussion/actemra-tocilizumab-to-treat-pmr/

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thank you for the valuable insight….this PMR is a …..bitch.

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@girastancil

thank you very much – which of these would you suggest by the way. I'm thinking of the tocilizumab you noted. thanks again

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@girastancil The only one I've done research on and thoroughly discussed with my Rheumy is methotrexate. Methotrexate is not an alternative to prednisone. It's used by some to help taper from prednisone. The results I've read are not good. There are side-effects to methotrexate and the benefits are limited. Most of the comments I read on the boards I'm on say it had no effect or caused other issues. Based on that and my Rheumy's research I chose not to try it.

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@kmeikle1

@girastancil The only one I've done research on and thoroughly discussed with my Rheumy is methotrexate. Methotrexate is not an alternative to prednisone. It's used by some to help taper from prednisone. The results I've read are not good. There are side-effects to methotrexate and the benefits are limited. Most of the comments I read on the boards I'm on say it had no effect or caused other issues. Based on that and my Rheumy's research I chose not to try it.

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I did try methotrexate along with prednisone. It did lower my inflammation markers to normal range for the first time in years. However, I did found I was very light headed and convinced my rheumatologist to let me go off it. Not sure if it was the source of the problem. It was better for a short period of time, but I am now battling light headiness again. Don't get labs run again until October, so that will be telling. I started at 20 mg of prednisone last November, am now at 3 mg and feeling really good. Keeping my fingers crossed that I can get off prednisone soon and not have the need for any meds. Have you discussed plaquenil? My rheumatologist indicated it was a possible option. Best of luck!

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@johnbishop

@girastancil, I don't have any experience with either but @dadcue started a discussion on tocilizumab and others shared their experience which may be helpful.

— Actemra (Tocilizumab) to treat PMR??: https://connect.mayoclinic.org/discussion/actemra-tocilizumab-to-treat-pmr/

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My rheumatologist started me on Actemra two months ago. What a difference! My PMR pain is pretty much gone. I have tried methotrexate which caused daily vomiting and Leflunomide which caused a horrible rash that lasted six weeks, miserable with itching.
I have had PMR for more than four years and Actemra is the first treatment that has given me hope. I still have extreme fatigue, but I can live with that being pain free.
I am now starting to taper from the 2 mg of prednisone I have been on for a long time that did nothing to help. I have lived with a flare for the last several months, but we didn’t want to go back up on it.
Actemra is worth a try! Best wishes!

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I have used diclofenac to manage pain, but it does not control the disease and there are warnings. I did not have issues except a slight increase in blood pressure. Might discuss it with your doctor.

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I have tried couple of times celebrex for treatment of arthritics, but while it helps, it gives same side effects as prednisone – pain in my stomach. I have ulcer history and cannot take NSAiD type of drugs, and prednisone is very bad for me. 8 years ago I had PMR and after taking prednisone for 1 monthI had to stop and was switched to Tramadol. I also was taking Suppement Zyflamend, and I got better in 16-18 months. After I got better my doctor told me a probably never had PMR, but had fibromyalgia. I Disagree, I had all symptoms of PMR, and elevated SED (55) and c-protein.

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I took diclofenac for over a year with good results. However, if you read about it the side effects are not encouraging. As long as I took it with food, it did not present stomach issues. It absolutely took away the pain from PMR. I can take only 25mgs now when I occasionally need to. Anyone else ever used this anti-inflammatory drug? It can drive up blood pressure.

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@lmoross

My rheumatologist started me on Actemra two months ago. What a difference! My PMR pain is pretty much gone. I have tried methotrexate which caused daily vomiting and Leflunomide which caused a horrible rash that lasted six weeks, miserable with itching.
I have had PMR for more than four years and Actemra is the first treatment that has given me hope. I still have extreme fatigue, but I can live with that being pain free.
I am now starting to taper from the 2 mg of prednisone I have been on for a long time that did nothing to help. I have lived with a flare for the last several months, but we didn’t want to go back up on it.
Actemra is worth a try! Best wishes!

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I could not tolerate methotrexate. Have you experienced side effects from taking Actemra?

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I have tried Actemra via injection the results were impressive for pain reduction however I previously had diverticulitis and it is a contradiction to actemra i did have a diverticulitis episode so needed to stop taking it.
I have also tried Leflunomide again results were quite impressive however one of the side effects is peripheral neuropathy i developed neuropathy in both my hands and feet it has been confirmed on EMG study so that medication was stopped.
I was them prescribed methotrexate injections again great results, i did not have any of the documented side effects however i did become infected with COVID during treatment. I ceased the first week i was sick with COVID as instructed. Six weeks later i was still quite sick and simply could not recover from COVID symptoms so the medication was stopped and i eventually recovered.
My rhuemy now wants to try Rinvoq she is not happy with me as i have refused this treatment for now, i would rather stay with prednisone as it is the devil i know type situation. Rinvoq has some serious side effects and after some serious research and contemplation i have decided to battle it through with prednisone. This is my 4th year with PMR and GCA and i have only managed to cease prednisone once in those 4 yrs and the remission only lasted 3 weeks.

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