Steroids not going in remissions. METHOTREXTATE//??????

Hello and sorry to hear your PMR not going into remission. I'm a newbie myself so I'm not speaking from lots of experience, but it took going up from 15mg, to 20, to 25mg Prednisone, then staying at 25mg for 2 weeks before all the pain and symptoms were gone. I've since started first taper to 22.5mg.
So far so good. Slow going and low doseage reductions is what my Rheumatologist and others here recommend.
As for Methotrexate, I've read a lot about it, especially because of the cost compared to say Kevzara or other prescriptions to help people get off of Prednisone.
I don't know how much or how long you've been taking Prednisone but it might be worth posting your doseage and for how long you've been taking it. It can take each person a different amount of Prednisone mg, and time to get it totally under control. For some people the first doseage gets it done in 24-72 hours, but for some of us it can take more. From what I've read about the possible side effects, and from some people's posts on this forum who actually took it with dire consequences (some were fine), I have no interest in taking that chance. But I'm 73, and have a few other issues like sleep apnea, chronic pain and breast cancer. It's something I hope you look into very carefully, discuss with your Rheumatologist, not just a regular PCP to get the knowledge of a Dr who most likely has a good bit of know and probably patients who've taken it.
I hope you put your Prednisone doses and length of time here and let others who know more than I do comment on it. May you find all the care you need with the least detrimental side effects and best possible Rheumatologist to guide you. Blessings

As a 79-year old female, I have been on prednisone for over two years, and was having real difficulties getting below 4 mg. My Rheumatologist started me on Methotrexate about 6 weeks ago, and I can tell it is helping. I'm down to alternating 3 and 2 mg. In two weeks I plan to drop to 2 mg daily. With methotrexate, however, you must also have folic acid daily. And there are stern warnings about using any kind of alcohol while on methotrexate, due to the increased possibility of liver damage. Fortunately, I was not a big drinker, but I do miss my daily 4 oz. glass of wine. 😒

It's very hot and miss with methotrexate. Occasionally some individuals get a good outcome with it, but it doesn't do much for many others, and some it makes very ill. Doctors seem to think it's more effective than the research demonstrates. But you could be one of people it does help. I would consider the risks carefully as it does have a lot of potentially nasty side effects

I was diagnosed with PMR in August of 2023. Started at 20 mg of prednisone. Reacted positively to the prednisone but discovered I had to taper very slowly. I got down to 5 mg and could not get lower without intense pain, my Dr recommended methotrexate. At first I said no but eventually tried it. I started at 4 tablets and slowly increased to 8. It took about 8 months but I was finally able to taper completely off the prednisone. No real side effects from the methotrexate. I was tired the day after I took it but that is about all. I stopped taking prednisone totally the first of July and felt good for about a month and then slowly the pain started to return. Mostly it was nighttime that I suffered the most. Dr put me back on 2 mg of prednisone. It took 2 weeks but I am feeling much better. We are considering my staying on 1/2 a mg for life once I taper back down to that level.
I know I am not supposed to drink while on methotrexate but we took a 2 week trip to Italy this summer and I did drink a lot of wine while there. My liver numbers were high when I got home but after 6 weeks of moderate drinking they went back down. I feel like a glass of wine now and then won’t hurt me and I still want to enjoy life so I imbibe now and then. I am doing yoga 5 days a week. I feel like that has helped me immensely dealing with this disease.

I had PMR initially, then was diagnosed with RA. I have done very well on methotrexate for the past two years. It enabled me to finally wean off prednisone. A year ago I switched to the injectable form of MTX because my rheumatologist said it was more readily absorbed than the pills (I was taking 10 pills a week), and four months ago I was able to reduce the dose. My liver numbers have been good and I was told I could drink in moderation. For me that is about 3-4 glasses of wine each week. I have never had side effects.

@bren0718 Your experience is encouraging! I was diagnosed with PMR in March of this year and prescribed Methotrexate late June. Mistakenly thought that after the concurrent prednisone taper I was on in July, I could go without. The first 3-4 days were okay but then the pain and stiffness came back full force. Rheumatologist upped the Methotrexate dose to 10 tablets all at once/weekly and prescribe 10mg prednisone daily. I've felt pretty good and more "normal" since. Have an appointment this week and plan to ask about lowering the prednisone dose. Kind of afraid to, but I know the docs don't want us on it for too long. But I do wonder: How do I know that the methotrexate is actually working when I'm taking the prednisone?

@bandorino
I was on 5 mg of prednisone for months and could not taper any lower because it was too painful. I started the methotrexate, it took a couple of months but all of a sudden I felt better and then very very slowly ( I did 1/2 a mg at a time) I would lower it about every 2 months. I knew the methotrexate was working when I could taper with very little pain. I was off of prednisone for 2 months and the symptoms slowly started coming back. So my RA put me back on 2 mg of prednisone
It took 2 weeks but I gutted it out and now I’m feeling a lot better. Will start tapering again in a couple months. My goal is back to 1/2 mg prednisone and then stay on it for a long while. Then I will start tapering the methotrexate. It is a long very slow process but the prednisone is not harmful to my bones at this dosage so I’m ok staying here for a while.