On this same subject, I am curious as to why MTX seems to be automatically prescribed along with Prednisone by some doctors when the Prednisone is obviously working on its own.

Is MTX for a specific condition in addtion to the myositis?

My understanding is the belief that you hit polymyositis hard the first 3 months with prednisone, start the Methotrexate, and by the time MTX starts working the prednisone tapering can start. MTX apparently has a significant reduction in side effects like insulin and hypertension during long term use, as opposed to cortisteroids. It's true docs used to wait to just see if Prednisone worked.

@wonup
I was never on methotrexate, so I can't give you any info. Sorry about that. I'm sure other will offer advice.

@Kathleen
Each doctor who works with DM or PM patients seems to have his/her own system. Part of the answer depends upon a person's response to prednisone, or lack thereof. My doctor started me on prednisone and nothing else. We started to taper quickly. His goal was to get me down to 40 mg., which he said I would be on for a loooong time. He told me that as long as the prednisone was working that he wouldn't add anything else. But he said at some point the prednisone would become less or non-effective, and that he would start me on another medication at that time. And when that medication no longer helped, then he would use a third. Or would combine meds. I feel really blessed to be off prednisone for a year now, without having to take anything else.

Methotrexate is considered a "steriod sparing" drug. Most doctors don't want to keep you on Prednisone any longer then necessary so they provide a secondary drug to hopefully get you off Prednisone.

A "standard" dose of MTX is 25 mg weekly. I would guess your doctor will increase you. I didn't have side effects from the pills until I got up to 15 mg. Be sure you are also taking Folic Acid. It is very important when you are on MTX.

Hope you are feeling good.

You are a lucky person to respond so quickly. 7 weeks seems like for ever, and prednisone quickly threw me into high blood pressure and high glucose. MTX will hopefully alleviate that as I taper the Prednisone, guess we'll see. Thanks Kathleen.

The methotrexate is a nice replacement for the prednisone over time. I have mild stomach issues with MTX. If you eat a full meal then take the MTX it helps the stomach. You can break up the dosage on MTX. I take 4 pills at lunch and 3 pills at dinner on Friday. 17.5mg total.

Some people prefer the injectable MTX to avoid stomach irritation. I tried the injection and it made my head feel weird, so I went back to the pills.

Prednisone is a very dangerous drug that has side effects severe to other body organs over time. Replacing the prednisone with MTX or imuran and moving forward is important. I will need to see an endocrinologist to see if I can even get off 5.5mg. I flared the last time I went down to 4mg and it seemed to weaken my heart which is a muscle. Good luck with your taper and keep us posted.

Thanks everyone. This really helps me prepare for upping MTX. I did add 4 mg folic 2 days after. I'll confess to the Doc next time I see her. Everybody has a slightly different experience, but it helps trouble shoot....

Hi
Yes there are horrendous side effects from both of the drugs. My hair thinned terribly on Methotrexate and prednisone. I went from 115 lbs to 165 lbs in 90 days and I was so miserable that nobody wanted to be near me. I now have a hump on my back and diabetes that they attributed to the steroids. The most horrible thing was when I researched and found out that the combination of the two drugs would destroy my liver and likely decrease my life by twenty years. I was only 32 and refused to curl up and die. I researched alternatives and was so lucky that I know several specialists who were willing to stick their necks out for me and encouraged me to do the antibiotic protocol. Fortunately for me, it worked and I have not had any symptoms of the disease for more than 10 years. I am pain free and am so grateful that I was able to think outside of the box. Perhaps it is because I have studied nursing and truly understand the politics involved in all of this

You are fortunate indeed! Glad the out of the box thinking worked for you.

It is so important for people to heal their bodies from inside out rather than taking medications that act as a band-aid. Researching is the key and finding a Dr. who has the confidence to treat a patient in a "different" that standard way. I hate to think what my life would be like now if I hadn't flushed the methotrexate and steroids down the toilet. You know, I always think back to the time I was on the ice, teaching a little boy to skate and I looked up and realized his dad was the Rheumy who sent me home to die. HE told me to spend as much time as I could with my little boy and start making some plans. HE told me to give up the dream of EVER thinking about resuming my professional skating career. Some how Karma put me in his face and I made him eat his words and hopefully enlightened him. When I told him I flushed all of his meds and was doing antibiotics, his response to me was, "ya, that stuff really works." Can you imagine, he knew all along that there was a choice and I didn't have to walk around looking like a balding, Goodyear Blimp. Can you imagine that he know that there was hope but chose to treat me like "just another sick person". I thank my lucky stars every single day that I had the guts to stand up to them all and be healed completely. I do hot yoga, skate (yes again) and climbed to the top of the wall at one of my son's wall climbing birthday parties. And...............he knew it all along. Yay for me and shame on the Doctor.

I'm glad the antibiotic protocal worked for you Lianne. It only works for those with a certain marker. Everyone else, well just doesn't get better with it. I think it is important to share your story but realize that not everyone is a fit.

I know the side effects of MTX and Prednisone are not fun but not everyone "dies" from it. I have been on both for the best part of 5 years. I get my glucose tested every 6 months. I also get my liver a kidneys tested monthly. I get a bone scan every 6 months. All have been normal for me. I don't like the drugs but the alternative is being in bed and unable to enjoy life. Unfortunately, when you have a serious disease, sometimes you have to weight the cost (with the side effects) with the benefit. For me, I begged for Prednisone because I was just that bad.

I'm with you Lexis. For blinking sake, get me drugs, get me back on my feet and able to walk, and we'll do a managed taper with the fricken drugs. I'm at the end of week 7, and ready to be able to walk more than 5 minutes with a walker. I can open the fridge door an lift milk out now, though. That's big......

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563757/
For your attention.
In this link i quote " Plasmapheresis removes circulating immunocomplexes and antibodies and has been tried in patients with myositis but is of dubious benefit.3,20,77 It did not improve muscle strength or functional capacity in a double blind placebo controlled study,3,20,"

About MTX side effects I felt them day two after taking my first dose. My stomach is always sensitive to anything even over the counter I u so I felt a little nauseated and mostly tired. The tired feeling went away after the third day though and my doc said usually over time the side effects start to lessen some. I had other complications though that made it necessary for me to discontinue use after week 3. Other than that those were my only problems with it and they were manageable.

Some seem to experience side effects really strong and some don t experience any. I hope it goes well for you :)

**that was supposed to be over the counter IBU