Rheumatologist Questions

Fibromyalgia rheumatica

The Prednisone, and methotrexate cause so much fatigue. I would like get off these medications, but don't want a relapse, I have had this since December 2022.

Female | 66 years old
Complaint duration: 12/6/2922
Medications: Prednisone, methotrexate
Conditions: Hypothyroidism,

3 Answers

have your doctor slowly wean off the prednisone and if that is tolerable, then 6 months later start a slow taper of methotrexate. PMR usually last about 2-3 years but 20% or more have chronic or relapsing disease.
If you try and fail, you can always restart medications. No bridges burned
There is no such condition as fibromyalgia rheumatica. There is fibromyalgia and polymyalgia rheumatica which is treated with prednisone. If a person cant be tapered off prednisone, it is recommended to add Actemra that is a self injection or IV that allows the prednisone to be tapered off and is in place of the methotrexate. Dr. Dore
I am sorry that you are having difficulties I presume that the prednisone and methotrexate have been used to treat polymyalgia rheumatica or what we call PMR This is an inflammatory syndrome of the elderly that is very responsive to prednisone, usually On occasions, we will encounter patients who have difficulty getting to lower doses of prednisone The big concern with chronic prednisone therapy, even at low dose, our side effects including osteoporosis, muscle weakness, bruising of the skin, cataracts, etcetera There is a new medication that is recently approved for the treatment of polymyalgia rheumatica when the patient has trouble tapering off or to lower doses of prednisone That medication is Kevzara or Sarilumab This is a medication in the category of Biologic and it is similar to a medication called Actemra, which is used to treat rheumatoid arthritis and giant cell arteritis In general, medications such as methotrexate and Plaquenil are not as reliably effective in trying to bring the dose of prednisone down in somebody with PMR From what I see here, you may very well be a candidate for Kevzara and I would encourage you to talk to your rheumatologist about that Best wishes to you