Hi and welcome - better here than not but better not here! However - you have PMR!
I had had PMR for at least 5 years before it was diagnosed and I responed straight away to 15mg pred and had a perfectly normal course reducing until last summer when I had a flare (almost certainly due to underlying infection) and have struggled to reduce since then with severe pain returning within a couple of days. However, I am now reducing by one quarter of a mg/day and so far it's been OK :roll: :wink: so having said that, I'll keep my fingers crossed.
If you look at the top of the page you will see search experience - if you enter methotrxate in the box you should get a list of all the posts here which mention it, it was discussed quite a lot a few months ago. There are small scale trials being done looking at its use in PMR, it is commonly used as a drug to reduce the amount of steroid used in other diseases but the results in PMR seem to be mixed. At present the consensus amongst the experts seems to be it should be kept for when a patient is having real difficulty reducing the steroid dose or MUST come off steroids for compelling reasons - having a lot of other things adversely affected by steroids such as diabetes, osteoporosis, high blood pressure and so on. Also it should be considered after a couple of relapses.
I wouldn't take it myself at present. It is used in rheumatoid arthritis, it doesn't always work there either. It is also a drug with a lot of restrictions and side effects and I do feel it shouldn't be flourished immediately someone is diagnosed with PMR.
It is a \"steroid sparer\" in this case. That means it might mean you can take a lower dose of steroids (which is a good thing) but not necessarily. It also does NOT necessarily mean that you can take it instead of the steroids - maybe, but not 100% certain. In PMR the steroids are used to reduce the inflammation due to the underlying disease to a level at which you can function with it. You give a dose to reduce the pain and stiffness, usually 15 to 20mg/day, and then start to reduce the dose to the lowest level that keeps it under control. The PMR may go into remission (stopping the inflammation effect) but until it does you will need a dose of steroid to keep the inflammation under control. Once you get to that lowest possible dose, you have to stop the reduction or you will just be back at square one. If you keep each reduction very small, you can react quickly if the new dose is too little and return to the old dose without too much of a problem. I'm now reducing at such tiny steps because previously even 1mg drops were too much for me to cope with and the pain was right back. This seems to be working. After 20 months on steroids I have reduced from 15mg/day to the equivalent of 8.5mg/day as of today. I have relatively little pain - as long as I don't try any heroic reduction or overdo it. I certainly don't need crutches (not that I could have used them the way my shoulders and arms were :roll: ) although fancy shoes are a thing of the past - long past!
If your ESR is sky high I would tender the opinion that going up to 10mg from 8mg may not be enough - a few days at 5mg above the current dose is recommended in some medical textbooks to deal with a flare with a quick drop back to just above the dose at which the pain returned. Then the reduction should be tried again after a week or so to stabilise. And most of us don't find painkillers do anything for PMR pain.
And in connection with the sky-high ESR - how high, and is it higher than at the beginning? And is the pain the same as at the beginning or is it different, in different places? Why have you got a collar - do you have a bad sore neck, scalp pain, headache, eye problems? As you have had PMR you are at risk of developing GCA - and whilst I don't want to scare you, that is a very different kettle of fish as without treatment you could lose your sight. And it doesn't appear with
.