So I have been diagnosed for about 4 months with PsA. Have an excellent Rheumatologist and Specialized Dermatologist. Was started on Enbrel 10 weeks ago, 10 mg METHOTREXATE orally just 3 weeks ago , and have been unable to wean off 20 mg prednisone daily.
My symptoms have not improved but have worsened. Worse tenosynovitis / synovitis in hands , feet , ankles , knees than ever.
My rheumatologist is looking to switch me to humira from Enbrel. But insurance barriers and prior authorizations are delaying the switch to date.
anyone have ideas? Does increasing methotrexate help. I really want to get off prednisone. Anyone with similar story?
Thank you
It can take a while for meds to kick in. Sometimes up to 6 months. People are usually started on low doses of MTX so it may be worth discussing this with your doctor.
That’s very frustrating. It sounds as though your doctor is in top of things, and switching the biologic may not be a bad idea.
Thanks Stoney for replying. Maybe increasing MTX is anoption to get off this dose of prednisone.? I would love that!
Stoney said:
It can take a while for meds to kick in. Sometimes up to 6 months. People are usually started on low doses of MTX so it may be worth discussing this with your doctor.
That's very frustrating. It sounds as though your doctor is in top of things, and switching the biologic may not be a bad idea.
I think of Mtx and prednisone as very different animals. Mtx is more slow release (and of course that's after the long lead-in) while prednisone is often used as a fast-acting stop-gap while you're waiting for the slowbies to get going. So for that reason it doesn't seem like an 'either / or' between Mtx and pred. But it would definitely be a good idea to ask your rheumy if upping the Mtx might be worth a try. It's early days with Mtx but perhaps more of it would make a difference sooner.
Just wondering, does your rheumy want you to taper down from 20mg pred?
Yes he does want me to wean down . But every time I drop down to 15 mg daily I get a resurgence of intense inflammation in feet, ankles, knees and hands.
It looks like you and your rheumy have got it all covered, which bodes well for the future at least. But, just in case, might that resurgence be a bit of a reaction to reducing the prednisone by any chance? Or perhaps it is so bad that waiting to see if it calms down is not an option.
Doxno said:
Thanks Sybil.
Yes he does want me to wean down . But every time I drop down to 15 mg daily I get a resurgence of intense inflammation in feet, ankles, knees and hands.
Hi doxno,if it helps it took me a good 12 weeks for metho to take hold when I first started (2009) it was 10mg as well, in the meantime i was taking alot!! of pain relief… but however much i hate taking it, i am now up to 17.5mg and it is better with higher dose…
My nurse daughter was trying to explain to me yesterday how long-term use of prednisone affects some things and changes how the body makes a different hormone (I think she said cortizol, but I'm having brain fog lately so I'm not sure). We were having a conversation about my past weird heart events (I went to the ER a couple times because of what I call a heart "explosion"). She was wondering if I had been on prednisone around the times my heart did those funny things. I wasn't. But, I was applying a LOT of betamethasone cream to my scalp and other psoriasis. She said maybe that was the cause, but that's confusing because I used betamethasone for 100 years (not quite, but forever) so why would I have 2 or 3 heart episodes?
We both agreed that prednisone is a med that should be used with caution and not long-term. If you take it long term, it will usually cause some problems when you try to wean off of it. Unfortunately, doctors never seem to explain the risks and disadvantages about drugs they're prescribing to us!