DEAR DR. GOTT:
I have been taking prednisone 10 mg daily for 14 months for PMR. I cannot take less than 8 mg without a lot of pain in my wrists and hands. I have researched this and discussed my concerns with my rheumatologist who has now put me on methotrexate (4 tablets of 2.5 mg once a week) to try to wean me off the prednisone. Is this the lesser of two evils? I worry about the long-term side effects of both medicines and more importantly, how to cure the PMR. Any suggestions?

DEAR READER:
Polymyalgia rheumatica is an autoimmune disorder that causes muscle pain and stiffness in joint areas. Relief is achieved by reducing inflammation with over-the-counter medications or, in severe cases, with oral steroids as the mainstay of treatment. PMR can be a disabling disorder requiring aggressive therapy in an attempt to reduce the body’s immune response. Unfortunately, the treatment is not without risk.

You apparently have progressed from over-the-counters to prescription medications, and I cannot advise you which drug to take. That decision depends on your response to each medication. Methotrexate is, in my experience, less troublesome than prednisonebut still has its own side effects.

Although some PMR patients suddenly improve after many years, PMR typically is permanent and incurable. Therapy to treat symptoms is extremely effective but must be taken for years.

I believe that you are in good hands; your rheumatologist has made sound decisions thus far. I urge you to stick with the recommendations provided. Periodically review your health issues with him or her and try to get by on the smallest amount of medication that controls your pain.