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PMR and Claudication

Posted , 9 users are following.

darlene96382
darlene96382

I had classic symptoms of PMR for about 3 months before being diagnosed in July, 2015.  I started at 15 mg Prednisone daily and have weaned to 6.5 mg. I'm 54 and was quite active before PMR, sadly that has all changed.  I felt really good the first month on Pred. and was able to return to walking my usual 3 miles a day then I started having pain in my calves so bad I had to stop.  I had never experience this before and discovered it was claudication. I have now been diagnosed with peripheral arterial occlusive disease.  I have no risk factors for this disease and have no other symptoms other that the calve claudication pain. Has anyone experienced this after having PMR and do you think it is related to PMR or just a completely different issue. My doctor is not aware of a connection with PMR but I'm not sure he knows that much about it. I have started walking again and am increasing my distance very slowly, stopping to rest when the pain is bad enough.  This forum is a blessing. Thanks to all of you!

0 likes, 16 replies

16 Replies

  • Handbrake
    Handbrake darlene96382

    Posted

    Hi Darlene,

    there have been some ultrasonography studies done that have revealed surprisingly frequency of large blood vessel involvement in people with PMR and GCA. One found 8% of this group developed lower extremity peripheral artery disease. Might be worth searching for other information on the Internet. 

    • Handbrake
      Handbrake

      Posted

      I've sent you a link with information via private message
  • EileenH
    EileenH darlene96382

    Posted

    You do have a risk factor for PAOD - PMR. PAOD can develop due to the damage caused by the uncontrolled inflammation - and it may have been going on for some time before it got bad enough to show the symptoms we call PMR.

    What tests have you had done? Have you seen a vascular surgeon for assessment? Yes, what you are experiencing is claudication - but that is just the name of the symptom. There are several causes and only proper testing will identify what it is. 

    • EileenH
      EileenH

      Posted

      And as soon as I shut the computer down I remembered that there is an increased rate of diagnosis of cardiovascular disease in the first year after diagnosis of PMR/GCA. 

      Another question - what dose of pred were you on when the claudication started? Did it start suddenly, from one day to the next? And is it equal in both calves? If it is it could suggest the blockage is possibly in the abdomen rather than the circulation in the legs and does need proper investigation.

    • darlene96382
      darlene96382 EileenH

      Posted

      The calve pain started about one month after starting pred and I was still on the starting dose of 15mg., over the last 11 mths I have reduced to the 6.5mg daily. The pain did start suddenly, I thought at first it was a side effect of the pred since it started shortly after I started taking it.  I mentioned the claudication pain to my Rheumatologist several times - no response, my GA finally referred me to a Vascular surgeon. I have had a bilateral ankle/brachial index test and lower extremity arterial duplex ultrasound showing bilateral superficial femoral artery occlusion with collateral vessel reconstitution distally. I started on Asprin 81mg daily and was encouraged to keep trying to walk. I'm making slow progress but progress none the less. 

      I had been using a class 1 (superpotent) topical corticosteroid 3-4 times a week for years for eczema on my arms. I stopped using it June, 2015 and within 2 weeks I started having PMR symptoms very suddenly. I did some research and thought I was in steroid withdraw, of course my Dermatologist didn't agree. Later when I was dx with PMR my GA said maybe the topical steroid had been keeping the symptoms hidden for awhile.  Does that sound possible?

    • EileenH
      EileenH darlene96382

      Posted

      Oh that's good (if you see what I mean!) - I was a bit concerned you hadn't seen a vascular surgeon as I know how difficult it can be to persuade PCPs that is what you need! My husband ran a vascular lab for about 9 years.

      I think it is very possible that you had had the PMR masked by the use of the topical stuff - but then it appeared properly when you stopped You can absorb quite a bit systemically, especially if it is high dose topical stuff.

      The walking through the pain is the first approach - it is said you can increase your capacity by over 10% if you apply yourself! And if you already have collateral circulation it may improve further. I do hope so. What did the vascular surgeon say otherwise?

    • darlene96382
      darlene96382 EileenH

      Posted

      That was about it, Asprin and try to stay as active as possible. I do have both vascular tests scheduled for a repeat in early December. Maybe I will get an early Christmas gift and everything will be better! My pedal pulses are easily palpable, good color, no other issues. My weight has stayed the same with pred, give or take 5 lbs. I'm 5'6" and weight 150 - 152 lbs most days. Some days I still have a little bit of stiffness in my hips with walking but seems to get better as I go along. I definitely feel better in the afternoon and evening so I try to do my exercise walk then if possible. Lately I've been able to walk 1.5 - 2 miles without having to stop if it's not too much of an incline. I have a fair amount of pain but can usually keep going. Thank you so much for sharing all you knowledge! This forum has definitely helped me keep my sanity.
    • EileenH
      EileenH darlene96382

      Posted

      Ah well - then no-one is going to worry too much if you can walk that far! It's the people who can't manage 100 yards who REALLY have the problems. I forgot to say - that it's been there a fair time already if you have collateral circulation, that takes a while to form.

      All the best.

  • sastew
    sastew darlene96382

    Posted

    Hi Darlene

    I am 50 and was diagnosed with PMR in Novmber 2015.  I began struggling with claudication about 2 months into using Pred - probably on 12.5g by then.  I contact my doctor who suggested that perhaps I just wasn't very fit and that claudication wasn't related to PMR or Pred.  I am so dissapointment with my doctor - but that's another story!!  The claudication is less now and I only notice if I'm walking uphill or particularly exerting myself.

    From the understanding I've gained on this forum (not from my doctor!) the inflamation caused by PMR means that blood circulation to and from the muscles is slower, therefore when you begin to exert yourself oxygen cannot get to the muscles quick enough and lactic acid etc cannot be removed quickly enough.  The sense I get is that my muscles just begin to tighten and harden and my legs and to some extent my arms, just refuse to move any quicker - I swim to and can't swim as fast as I used to, my arms will just refuse to move!

    Frustrating though it is, I don't know that it's something to be too concerned about as long as you continue to exercise.  it's just another frustrating side effect of PMR - although my doctor doesn't think so!!! 

    • darlene96382
      darlene96382 sastew

      Posted

      My problem is also much worse with inclines and it is that extreme tight feeling in my calve muscles. Frustrating is definely the word to use!! Thank you so much for your response.
  • jenny758
    jenny758 darlene96382

    Posted

    Hello, I am a 58 year old female diagnosed in April 2016 symptoms began in dec 2015  I am happy to find this forum and others with the same problems.  My right calf started hurting a lot today, although both calves frequently feel odd - hard to explain but to dr but at times they feel tight or "full" for lack of a better word.   this pain today is new but I did a little more walking today than usual so not sure if that caused it.  I see my dr tomorrow n will be asking him about the claudication you mentioned. I'm on 25 mg predisone daily. 800 mg ibuprofen every 6 hours and 300 mg neurontin every 6 hrs.  My pain and lack of easy movement/ range of motion has been limited to shoulders upper arms and thighs until today when the calves decided to join the party.  The prednisone has helped my legs tremendously.  I feel and understand your challenges with this disease and I am glad I stumbled across this forum.  Sending healing thoughts your way 
    • darlene96382
      darlene96382 jenny758

      Posted

      I had pain initially in my hips, upper thighs and shoulders when first diagnosed with PMR. I felt so much better when I started on 15 mg of prednisone and could actually walk for exercise again. After just one month the calf pain started. PMR is such a struggle but we must keep pressing on. Have you heard that there could be an increased risk of stomach ulcer bleeding if you take Ibuprofen and pred?
    • EileenH
      EileenH jenny758

      Posted

      Claudication is pain that specifically occurs on use of the muscle concerned which then stops when you stop the action only to return again when you restart the activity.

      A lot of people find they have tendon problems that make their calves feel very uncomfortable. Pred can affect tendons although it doesn't happen to everyone. You could try doing very gentle achilles tendon stretches and see if that helps at all.

    • EileenH
      EileenH darlene96382

      Posted

      You should have been told that you shouldn't mix NSAIDs of any sort (ibuprofen is one) with pred. Each is capable of causing irritation of the stomach lining and together the risk is greatly increased. It always helps to take pred with food - although even a yoghurt is enough and has helped many of us avoid the PPI tablets (omeprazole etc) or Zantac that is the other option.
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