Posted , 6 users are following.
I would like to know if any PMR sufferers have contracted the Peripheral artery disease, especially in their legs, after being diagnosed with PMR, if so how were they treated for this condition?
0 likes, 22 replies
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robin11917 track
Posted
Hi track, Haven't heard of this but will talk to my doctor next visit. He at least goes and hunts up information and we have discussion about it. He is still insisting that I get the prednisone down far quicker than the dead slow method and that is leaving me with a lot of pain and somewhat restricted movement. Will let you know if he comes up with anything.
elizabeth20640 robin11917
Posted
That's interesting Robin I'm down from 80mg to 6mg but in last 7 weeks have a lot of thigh pain, CRP and ESR are up slightly, but still wonder at this stage could it be steroids,
EileenH elizabeth20640
Posted
If your CRP and ESR are increasing then it is far more likely that you are down to a dose which is too low to control left-over inflammation and it is increasing. The pred hasn't cured anything - it has been managing the symptoms to give you a better quality of life until the underlying cause of the GCA has burnt out and gone into remission. As long as it is active you can have PMR symptoms, especially if you were someone who had PMR as a symptom of GCA. If the blood supply to the thighs is not enough it can cause pain when you are walking uphill or upstairs for example - much the same as in PAD but for a different reason. PAD is due to blockages on the inside of the blood vessels, in PMR the reduced blood flow is because of the inflammation narrowing the blood vessels.
CRP could be raised in both - but if you have a history of PMR or GCA then that is more likley to be the reason.
EileenH track
Posted
PAD isn't something you contract/catch as such - it most often develops due to athersclerosis, the build up of fatty material on the sides of the arteries which then restricts the blood flow and that is what causes the symptoms of sore legs when walking or cramps. There are several risk factors - aging, family history and existing cardiovascular disease can't be altered but cigarette smoking, obesity, diabetes, lack of exercise and high blood pressure can. You can have PVD, peripheral vascular disease which affect both arteries and veins or PAD which only affects arteries.
If you google healthline peripheral vascular disease you will get a good easy to understand article about it and ways of diagnosing and managing it.
There is some dispute amongst rheumatologists about PMR and GCA increasing our risk for PAOD - peripheral occlusive arterial disease - but since one of the risk factors is inflammation of blood vessels I think it is fair to say that PMR can tend to make it more likely but the propensity to develop it may have been there anyway. According to the medical literature there is a higher risk of cardiovascular disease as a result of GCA and PVD is more common post-GCA so patients should be monitored for it. Unfortunately - rheumatologists aren't often vascular medicine specialists so they may not be so aware of it and since GCA and PMR patients are relatively speaking short-term patients for them they don't see it developing as the patients have long been discharged. It also is the case in RA patients - I imagine they tend to see them developing it though as once you have RA you aren't very likely to be discharged from your rheumy!
Have you been diagnosed with PAD or have you symptoms that are suggestive of it? As the article I've suggested you look for says, how it is managed depends on how bad it is. You start with lifestyle changes and possibly medication and if it progresses there are surgical options if the blockage is limited. If a lot of the arteries are affected it is more difficult and if it is very severe and an operation isn't possible then something called sympathectomy (an operation on the nerve supply) may be done to improve the pain and it may also improve the blood flow to some extent. In the final analysis, if it progresses too far for these measures and the blood supply is too low to keep the tissues alive then amputation must be considered but that comes a long way down the line.
track EileenH
Posted
No I have not been diagnosed with this though I was googling info on it and read that people with PMR can develop PAD. I think I have the symptom, I cannot walk far now without aching legs and sore muscles in legs, and going up a slight incline, is very painful, on stopping and resting the pain goes away. One of the symptons is leg numbness, I do not have that though I have numbness on the outside of my feet. I also have a couple of small sores on my feet which will not heal, which is another symptom, the most unusual symptom I have is no hair growth on my legs for over 7mths now, which is another symptom for this PAD. I have spoken to my Dr re numbness in feet and he said it could have been an old injury, well I have never had an old injury to my feet. I got my information from the Mayo Clinic USA, by googling Peripheral artery disease (PAD).
I am due to visit with my Dr next week, so I will be taking along the information on my symptoms. I am waiting on a visit to a Haemotologist re my FBC which has been abnormal for the last 3 blood tests, Dr has ordered me to have FBC monthly re this problem, he thinks could be Prednisone causing this problem, but is not sure.
I have been tapering down very slowly and am down to 7mg, though really I must admit my pains in legs have worsened on the 7mg dose. I will have to go up to 8mg which I have done twice before, seem to have trouble getting below 8mg.
Have you heard of other PMR sufferers getting PAD?
Thank you for recommending the healthline article to google which I will do.
Thank you for your advice, much appreciated Eileen.
EileenH track
Posted
The lack of hair on your legs COULD also be due to confused adrenal function - loss of body hair and growth of hair where it isn't normally are both pred side effects. The poor healling is also a pred problem and I do know of several people with PMR who have developed peripheral neuropathies and numbness as a result. The fact that the pain obviously diminishes when you take a higher dose of pred could well be the indicator that yes, you have the signs of PAD, but it is actually due to restricted blood flow due to narrowing due to inflammation.
Has he said what is abnormal about your FBC?
As a start, your GP can start by doing a very simple test: taking your BP in arms and at the ankles and working out the ankle brachial index - google it for more details and it must have been in the Mayo article.
Sorry - must dash, husband is waiting for me!!
track EileenH
Posted
My FBC shows slightly high WCC, MCH low, RDW low, Neutrophils H, Lymphocytes slightly high, platelets H 476 (150-450) so not too bad.
Pathologists comments - Mild neutrophilia, mild thrombocytosis. ESR good 34, previously 6 months ago was 98.
Dr cannot tell me if Prednisone is causing all of above, needs Haemotologist to give opinion.
take care, T
EileenH track
Posted
Obviously didn't listen to his haematology lectures then - though I will allow there is perhaps one slight anomaly there though probably not.
Pred increases the total white cell count, mostly because the neutrophils increase. That's those dealt with. Pred usually lowers the lymphocytes but it does depend what your normal is and what disease you have. Autoimmune disorders and vasculitis are two of the causes of raised lymphocytes. And viral infections.
The pathologist must be in a timewarp - an ESR of 34 is no longer considered normal - it is raised and suggests inflammation somewhere. Which could well be the cause of your raised lymphocyte count.
Not the pred - probably the PMR.
Anhaga track
Posted
Track, your symptoms sound uncomfortably familiar. Do you have leg pain when at rest? I often get a burning sensation in my legs when I walk, especially when going uphill. In fact someone observing me struggle up a hill the other day commented that I looked like I wouldn't make it. He pondered whether he should rush out and help me along!
And unless I keep my legs very warm at night with a hot water bottle pain can keep me awake. All the rest of the time I have no leg pain.
EileenH Anhaga
Posted
Anhaga EileenH
Posted
Just looked PAD up and it describes the pain as "cramping". Definitely not what I'd call cramping. Good thing?
EileenH Anhaga
Posted
Only ever having seen patients with it and never having had it - I think the cramping is the claudication pain (when walking), I'm not sure the night-time pain is cramping. Does this help?
"The inner lining of arterial blood vessels is normally smooth, allowing blood to flow easily. In lower extremity PAD, the lining becomes damaged, leading to buildup of cholesterol and other lipids, causing the arterial wall inner lining to become rough and thickened. This accumulation is called atherosclerosis, or "hardening of the arteries." As the atherosclerotic process of the lower extremity arteries increases, the arteries become narrowed or blocked, causing blood flow to decrease. This can lead to discomfort, cramps, or pain in the hips, thighs or calves with walking. This is called claudication.
Claudication typically occurs during physical activity such as walking and is promptly relieved by a brief resting period (2-5 minutes).Normally, blood flow can increase up to ten-fold to meet the increased need for additional oxygen in exercising muscles. However, when the leg arteries are blocked, blood flow cannot increase in response to exercise and pain develops.
Claudication pain always involves the same muscle groups, usually the calves, and does not change from day to day. The vascular surgeon relates the onset of claudication pain to a particular walking distance in terms of street blocks (e.g. "2-block claudication"
or distance traveled before the symptom occurs. This helps to provide a standard of measuring if there has been any change before and after therapy has been initiated.
As atherosclerosis progresses and blockage becomes more severe, pain may occur in the feet even when at rest. This pain, known as rest pain, occurs because the arteries of the leg can no longer deliver adequate blood flow to the feet, even at rest. Rest pain generally worsens when the legs are elevated, such as when lying in bed at night. Relief from this pain may occur only when the feet are dangled.Gangrene or "death of tissue" may occur when nutrition needed for normal growth and repair can no longer be provided because of extensive arterial narrowing (stenosis) or complete blockage (occlusion) of lower extremity arteries.
Currently, atherosclerosis affects up to 10% of the Western population 65 years or older. When claudication is used as an indicator of lower extremity arterial disease, estimates are that 2% of the population aged 40 to 60 years and 6% older than 70 years of age are affected. With the elderly population expected to increase to 22% by the year 2040, lower extremity arterial disease will be even more common."
track Anhaga
Posted
Sorry for the delay in answering, have had my Computer in for service.
Yes my legs to burn when walking up a slight hill, though not at night time, only when walking up inclines etc. My leg muscles also become quite sore to the touch. I mentioned to my Dr last week about Peripheral Artery disease, he did a few tests, and said he did not think I had this problem, but he will keep an eye on me in regards leg pain, I have had this leg pain on and off for about 7 months now.
take care, Track
EileenH track
Posted
My legs object to hills - and my muscles hurt to touch. But i'm fairly sure it is the PMR. It wasn't there last year and has reappeared since the flare I had in February.
linda17563 EileenH
Posted
EileenH linda17563
Posted
Yes - one of the 82+ side effects of pred, same as raised blood sugar is also a possible result of pred. Pred affects how the liver works - most of our blood cholesterol is produced by the liver which is why diet doesn't make a massive difference unless you were eating an absolutely disgusting amount of fat before!
I think I've responded to you about the low back and thigh/leg pain somewhere else? I doubt it is claudication because it includes the back, but I would wonder about myofascial pain syndrome or piriformis syndrome - both often found alongside PMR. They'll improve a bit with higher doses of pred but not permanently and return with lower doses.
track EileenH
Posted
My blood test FBC was the same ESR down to 32 very good, Ref: (1-35), he seems to think this is very good, my CRP high at 79.5 mg/L.
Anhaga track
Posted
I think this discussion has raised enough questons for me that I'll bring it up with my gp at next appointment. Better safe than sorry!