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Differential diagnosis

Posted , 5 users are following.

paul45653
paul45653

To repeat background info as an aid: 1st symptoms, Jan 2014. Diagnosed PMR May 2014. Current dosage pred, 9/10 mg. Current age 84. 

First, my apologies to the ladies on this forum most of whom suffer more than I and have many different reactions to both the disease and the meds. I know that my problems may not resemble yours. 

I am today seeking some information regarding PMR symptoms in lower extremities as opposed to same symptoms caused by claudication. The claudication is well known to occur in the aged and eds up being caused by the same inflammation due to decreased blood supply. I found that I was so getting accustomed to the 2 to 3 level pain which we call "stiffness" that I failed to put it in perspective as a treatable leftover of wrong dosage or early tapering, or of a different problem, claudication, which is also treatable and more positively diagnosed. Right now I am halting the dosage taper untill I can get a reading from a vascular specialist if possible.

Paul

0 likes, 5 replies

5 Replies

  • EileenH
    EileenH paul45653

    Posted

    The vasculitis in PMR and GCA can cause damage to arteries and end up leading to peripheral vascular disease which is the usual cause of claudication - you can't really separate them in that sense. Whether claudication is treatable or not does depend on what is causing it. It can be a discrete blockage reducing the overall blood flow which can be stented or resected or it may be large amounts of narrowed blood vessels which are too much to resect and so you have to go about it in different ways. A first approach is to "walk through the pain" - try to walk a bit further past the pain starting. You should get up to a 25% improvement in performance in time. Then there are various approaches a vascular specialist would consider.

    But frankly Paul, if I were you at your age I'd up the pred to a more comfortable level whatever. 

    • paul45653
      paul45653 EileenH

      Posted

      Thanks Eileen for your fast reply. What your saying makes sense to me. My first Rheumy who prides himself on being an expert in PMR, was hell bent on reduction so I changed to one who just started in my local clinic. She was recommended by my GP. I was in shock to learn at first appointment that she studied under my first Rheumy and was also after a rapid taper just because my sed rate etc was normal. I will have to proceed as many here have done, and take it into my own hands.
    • EileenH
      EileenH paul45653

      Posted

      But the sed rate is normal BECAUSE of the current dose of pred - so you reduce in small steps to find the lowest dose that keeps it at that normal level. I really don't understand how they don't know what the mechanism of the disease and pred is. 

      They spend a lot of money going to medical  school - and apparently learn very little! Why not take the links here that are aimed at GPs

      https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316

      to your GP and get them to manage you? All you need is the pred and he must be able to provide that.

    • tina-uk_cwall
      tina-uk_cwall EileenH

      Posted

      Hello Paul, when so called specialists attempt to reduce the medication, prednisone too quickly and by too great a drop it actually proves that whatever they are specialists of, it most certainly is not PMR. The dosage of prednisone has to be high enough to control the inflamation. The inflamation, no matter what the experts say, cannot be made to fit the dose of medication. So it's slow reduction and by the smallest amount of prednisone as possible wether they like it or not. I agree with Eileen, if you are still experiencing pain and stiffness up the dose and stay on that dose for 4-6 weeks then taper down slowly by small reductions. Good luck paul. Regards christina 
    • paul45653
      paul45653 tina-uk_cwall

      Posted

      Thanks for  the encouragement Christina. I'm pretty much convinced I know how to handle these people now. Its a shame they actually take offence when you come in armed with valid information.

      Paul

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