New skin rash - purpura?

[Winter_night]

Hi all

Thanks for taking the team to read on….

As I’ve mentioned in my previous ‘newbie’ post I’m in limbo somewhat as I have what feels like an ever growing list of CTD signs but I’m waiting on my latest blood results and dates for various investigations my rheumatologist has requested.

Yet another oddity has appeared on my thigh and I’m worried it’s purpura. I have erythromelalgia and it’s been particularly bad today - hence I’m not sure if this bruise/rash is the erythromelalgia or if it is something I should speak to my doctor about? My ankles, knees and hands seem slightly puffy too in recent days. Is purpura a lupus thing in anyone’s experience? I have attached a pic.

Thanks ever so much..

Frances

[MrsMarigold]

Hello WinterNight. It appears in your picture to be a simple bruise. Purpura presents very differently as reddish and purple plaques usually in groups on skin. It is a good thing to take pictures of your skin symptoms. It helps Doctors make a solid diagnosis. Best, Titters

[Winter_night in reply to MrsMarigold]

Thank you Titters. It has almost completely faded overnight, phew! I’m definitely anxious at the moment, questioning everything. I have no idea how I managed to bump it and not notice but I am insanely clumsy at the moment too 😁 All the best X

[Spanielmadlady]

Looks like a bruise to me too.i get them appearing without any apparent reason x

[Winter_night in reply to Spanielmadlady]

Thank you Spanielmadlady, it has faded overnight thankfully. I had a rough day yesterday and was definitely in catastrophe mode! 😆 I have had some seemingly random bruises too but I know from my bloods there’s nothing sinister. More likely chronic clumsiness. All the best X

[Spanielmadlady in reply to Winter_night]

I go into what I call clatter mode .....my favourite is bruises on forearms from door handles 🙄 .don't stress about an increasing list of symptoms...we've all got one as long as our arms.keep smiling xx

[Winter_night in reply to Spanielmadlady]

I can relate to that 😆 And that’s good advice! X

[PMRpro]

That looks like a plain ordinary bruise. Purpurae/petechiae (tiny ones) are darker are more defined and tend to fade to leave a brown mark

[Winter_night in reply to PMRpro]

Hi PMRpro, thanks… I feel a bit daft now but I guess it’s good to be vigilant! 😄 All the best X

[PMRpro in reply to Winter_night]

If you haven't had them before - why should you know? I have them on a permanent basis - thank you pred!!!!

[KayHimm in reply to PMRpro]

Change of subject but didn’t want to forget to tell you that a big study came out of Sweden on comparing RA patients on long term 5 mg prednisone (with other immunosuppressants in some) and those without. Damage was significantly less in those on prednisone and side effects negligible. This goes against current recommendations and apparently will be a big shift. The article said many rheumatologists ignored the recommendations and kept their patients on low dose prednisone anyway.

Thought you would be interested.

[PMRpro in reply to KayHimm]

I know that there are rheumies using the "old-fashoned" recommendation of low dose pred for RA, usually 10mg. Be interesting how they adjust - they keep telling us that ANY rheumy would choose methotrexate over pred.

[KayHimm in reply to PMRpro]

Well, I think the patients did better when on 5 mg prednisone plus the DMRD. The recommendation has been to keep patients off steroids if I read it right.

These studies keep adapting, then re-adapting. I don’t have arthritis so it is not an issue in my case. I believe it was a Medscape article that came in my email.

I just read Humira has been successful in some patients with dysautonomia. No chance I would be given this off-label, though. Too expensive and not enough evidence.

[PMRpro in reply to KayHimm]

Doesn't surprise me to be honest - DMARDs may do some things well, there are problems they don't address that relate even more to QOL where pred does help. I've been on far too much pred for far too long for comfort but I haven't had any concerning adverse effects to date that I know of but I have had 13 years of pretty decent life all things considered and have been able to function which was the main thing.

[KayHimm in reply to PMRpro]

The quality of life issue is huge! I brought this up to my rheumatologist last time I was in. That risk/ benefit ratio has to be more carefully considered and adjusted with age and new illnesses that may limit life expectancy. He agreed. He did insist on getting copies of the last bone density, though, since I had had radiation to the pelvic region. I was lucky - no additional loss from it.

Happy you have done well with no major side effects. This new study may result in a shift regarding prednisone use.

[PMRpro in reply to KayHimm]

Our local osteoporosis guru insisted on getting my dexascan results - only sent to me by the private clinic that provides the service. Her face was a picture - she'd never seen results like them in a patient on pred! Just keep on what you are doing she said

[Pumpkin2009 in reply to PMRpro]

Are you saying that the pred has not hurt your bones? That is good news. I have been treated for osteoporosis for years before being on pred. The standard meds have not been very affective. My doctors are pushing me to go the Prolia route and I have been very hesitant. The endocrinologist in my last virtual appt. really was making a case. I am worried about the side affects being locked in my body for 6 months. I had been on Forteo at one point and was sicker all the time. I have had broken bones, but from falls. And yes, by dexa scans continue to get worse. Unfortunately, I have other contributing factors toward bone loss, lupus, hyperparathyroidism, deficient Vit. D, pred, , who knows what else. I wish I wasn't being so skeptical and chicken about Prolia. Glad to think that maybe the pred isn't so bad. Like I said, I was already diagnosed with it before the pred. Glad you brought this up.

Healing hugs.

[PMRpro in reply to Pumpkin2009]

It was used for my husband - he seemed OK with it but it was during the last year of his life so a bit difficult to say I suppose.

I'd have thought that if you have hyperparthyroidsm that hasn't been corrected, even Prolia will struggle to change things round but I'm no expert.

My worst t-score was -1.5 2 months into pred and over 11 years later it was -1.6. I do take a lot of care to avoid falls though!

[Pumpkin2009 in reply to PMRpro]

Thank you for your response. They won't treat the hyperparathyroidism unless the calcium is high. My Dexa scan scores from a year ago April were : Bone Density Scan dexa (4/21) - rt hip tscore (-3.6), lt hip tscore (-3.2), forearm tscore (-2.5) - osteoporosis. I am really trying to do the right thing, but it isn't so easy.

Have a good weekend.

Healing hugs.

[KayHimm in reply to PMRpro]

Yes, you seem to really be able to counteract the prednisone side effects. 💃🏻 I have starting eating yogurt - have never been consistent with calcium pills - and hoping to not go into the osteoporosis range. The low carb is important too. You are right about that. I am back on the program! Hope A1c is better in six months.

[Pumpkin2009 in reply to KayHimm]

Hi Kay, Hope you can lower your AC1. I am showing pre diabetes since I had Covid in Nov. 2020. Not sure if that is the cause or not. Glad your bones are working to stay healthy. My last scan results were - Bone Density Scan dexa (4/21) - rt hip tscore (-3.6), lt hip tscore (-3.2), forearm tscore (-2.5) - osteoporosis.

Have a nice weedend.

Healing hugs.

[PMRpro in reply to KayHimm]

Do you have a link/title for it? Could be useful ...

[Krazykat26]

Yeah I go with the others here Wn 🤗..it's a bruise. Always good to check though so don't feel embarrassed..we have to be vigilant 💜🌈😽😽xx