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Im trying to reinvestigate the subject of claudication.

Posted , 7 users are following.

paul45653
paul45653

Recent ruemy visit determined that based on labs, I should not have gone up to 15 mg to relieve apparent claudication in upper and lower legs inhibiting me from walking any great distance without rest. She referred me to GP to get referral to vascular specialist for eliminating arterial problems as a cause. GP checked all my pulses an did not find any abnormalitied. He did see a good possibility of nuerogenic claudication originating from lower spinal stenosis. I have a very dodgy spine. Ruemy has me reducing 1mg per month, I'm now at 14 for 2 weeks. I see the vascular specialist in the 14th. Coming down from 15mg, does anyone feel I could have dropped to 12 1/2 and then slower?

2 likes, 13 replies

13 Replies

  • tavidu
    tavidu paul45653

    Posted

    Hi paul

    I have slowly dropped from 25mg down to 14mg over the past 6 months but have noticed more aches and twanges in my legs since my drop from 15mg to 14mg 7 days ago, so I feel that a large drop from 15mg to 12.5mg would have been to much at this stage. Slow and steady is recommended and 1mg a month is wise. Good luck.

  • ptolemy
    ptolemy paul45653

    Posted

    1mg a month reduction sounds reasonable. Why do you want to go faster? Taking it slowly definitely has payed off in my case. Hope all goes well with the vascular specialist. I am seeing one at the end of April! 
  • tina-uk_cwall
    tina-uk_cwall paul45653

    Posted

    Hello paul, I stay on each .5 dose for 6 weeks, too long I hear you say! No I want each dose to really do its best and really get on top of any inflamation. I agree with tavidu, slow and steady. All the best christina
  • MrsO-UK_Surrey
    MrsO-UK_Surrey paul45653

    Posted

    Paul, yes it is possible to reduce successfully from 15mg to 12.5mg IF 1) you have remained on the 15mg dose for a sufficient length of time and 2) your symptoms, together with your repeat blood test results, allow.  I am proof, having experienced this drop successfully, although my high 40mg starting dose (PMR and GCA) may have given me a head start!  BUT we are all different and what suits one may not, of course, suit another.  If you have previously been at a lower dose and experienced worsening symptoms necessitating the increase back to 15mg, then the second time around it can be easier to return back down through the doses a little faster than previously, but only to a dose just above where the inflammation previously began to take hold again, and then remaining there for several weeks.

    I experienced claudication in my legs making it difficult for me to walk very far, sometimes having to sit on the nearest available wall until the pain eased, but at the time I accepted it as being part and parcel of PMR.  Very gradually I found that I could walk a little further before the pain set in but even then the odd more painful day would catch me unawares.

    I do sympathise with your spinal problems as I have spondylolisthesis (a slippage of the lower spine) .  PMR together with spinal problems can prove very testing, not knowing which pain is which.

    Anyway, Paul, good luck with the 14mg dose, and do try not to concern yourself with whether you could have dropped any lower. Even the smallest drop is a drop - It's how you feel now that is important.     

    • paul45653
      paul45653 MrsO-UK_Surrey

      Posted

      Thanks Mrs O. I was reading all the reduction stories in which the drop was from 15 straight to 12.5.
    • ptolemy
      ptolemy paul45653

      Posted

      Paul, some people take the coated version of pred which comes in 5mg and 2.5mg tablets only. They have the advantage of getting into the gut before they act so do not cause the stomach problems that the non coated ones sometimes do. The coated ones cannot be cut. This may be why it seems that people are taking 2.5mg drops.
    • EileenH
      EileenH paul45653

      Posted

      There is a paper from two former members of the Bristol rheumatology department with their recommendations for a reduction plan which is aimed at GPs to help them manage their PMR patients (there is also a section on GCA but that should really be referred to an expert rheumatologist). They start patients at 15mg for 6 weeks then 12.5mg for 6 weeks before leaving the patient at 10mg for a year. They find this reduces the flare rate from the 3 in 5 which is found with other reduction schemes to 1 in 5 which is obviously preferable. However, many patients find even 2.5mg drops too much and suffer steroid withdrawal pain which can be very similar to PMR pain - confusion ensues. Experience has shown that 1mg or even 0.5mg drops end up being faster than dropping in bigger steps and having problems and getting into a yoyo pattern of doses which seems to make later reductions even more difficult.

      There is evidence that patients who have had PMR have an increased rate of PAD (peripheral arterial disease) so any sign of claudication really should be referred to a vascular specialist for tests - a GP may be able to do it but only if they have a doppler ultrasound to listen for the ankle pressures. An ordinary stethoscope isn't adequate.

      However, I had calf claudication for a time which was due to tight muscles impeding the blood flow. It isn't always PAD and a physio may be able to help with stretching exercises. The first approach with claudication is also often what MrsO referred to and a walking programme used to increase the distance walked - you walk until pain and then walk a little bit further before resting. Then you walk and rest in the same way again and again . Doing this you can increase the walking distance considerably. You can find more detailed descriptions of such walking programmes on the internet.

    • paul45653
      paul45653 EileenH

      Posted

      Thanks much Eileen,

      I'm sure the vascular md will have some special kit to listen to my old arteries.

      Thanks to you all who responded.

    • EileenH
      EileenH paul45653

      Posted

      I'm sure he will - but in the UK at least there are GPs who will claim they can do it without the gear, get the wrong answer and won't refer! I've done it in the diagnostic lab - it ain't easy even when you are very experienced!
    • paul45653
      paul45653 EileenH

      Posted

      If he finds something vascular or ortho causing my claudication, I would expect my PMR diagnosis to be reexamine.
    • EileenH
      EileenH paul45653

      Posted

      Why? Do  you not have any other signs of PMR? You are correct in thinking claudication on its own is not necessarily PMR but there is no reason at all for a reexamination of the diagnosis simply because vascular disease is causing claudication - having PMR can predispose you to developing arterial disease, it isn't necessarily an either/or, you can have both.
  • misdiagnose
    misdiagnose paul45653

    Posted

    It's blood pressure in all 4 limbs that needs checking Paul. You don't say what your diagnosis is but GCA could be causing the problem.
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