PMR and Phlebitis

[piglette]

Has anyone else been treated for phlebitis who also has PMR? I had the diagnosis yesterday from a vascular surgeon. I am having the vein in my upper thigh sorted out next month using a local anaesthetic, VNUS I think the procedure is called. I am currently on 10mg of pred, is it a good idea to increase the dose before the op and if so how long for?

[PMRpro Ambassador]

Discuss it with the surgeon and anaesthetist. It used to be automatic practice to increase the dose for surgery but in the meantime they have decided that isn't necessarily needed and just monitor you carefully especially if it is just a local anaesthetic.

Someone said they'd had a PE (pulmonary embolism) recently and when I had a good online search I discovered a study showing that people with GCA have a three times higher risk of venous thrombosis in the first year after diagnosis. Do they tell us to watch out? Do they heck!

So - pleased it turned out as phlebitis and hasn't progressed to a PE. Because people with PEs are usually pretty poorly people.

Good luck!!

[piglette in reply to PMRpro]

I must admit I was quite relieved to have the diagnosis. The surgeon did say that he sometimes gave a quick largish dose of steroids to patients. I must ask him how many PMR people he comes across. He did say that the average ESR he comes across for it is 120 pre pred which seems high. I wonder if only certain PMR people are sent to vascular surgeons.

[PMRpro Ambassador in reply to piglette]

The fundamental problem is they don't know how many of us are actually GCA patients - there are still a lot of doctors who think GCA has to affect the temporal artery. No it doesn't - you can have rampant GCA all over your trunk and into arms and legs that doesn't get to the head so you get no cerebral symptoms but you do get PMR symptoms with the odd GCA symptom: jaw, leg and arm claudication, sore throat and cough to mention just the ones I had. But I had a normal ESR - I assume usually the patients with "just PMR symptoms" with a high ESR probably have more extensive inflammation.

They KNOW that there is an increased risk of thoracic aortic aneurysm and recommend screening of all GCA patients for that with a chest x-ray every couple of years. According to Kate in her book, it isn't done because they can't do anything about it - which isn't entirely true. Twenty years ago they couldn't do anything, now they have stents which can be tried if it gets to the risky stage. Techniques have changed a lot in the last 10 years.

[mk14]

This doesn't answer your questions but just thought I'd add my experience. I had superficial phlebitis in my upper arm after about 3 yrs PMR. They didn't treat the phlebitis as it went away, but did a scan to check there wasn't a deep vein thrombosis which was reassuring.

[piglette in reply to mk14]

Thanks MK14. Hopefully having my lumpy veins zapped will solve the problem. The vascular surgeon said they would not go away but get worse sadly. He said after the op everything is wonderful and then after a few days the pain sets in. Sounds like PMR and the honeymoon period when you first start taking pred and then the shock when you reduce too fast!

[northants]

I had phlebitus about 6 years ago and it took about 9 months on anti-biotics to clear it I had been fine since until after Christmas after beeing on 10mg pred doctor put me down to 9 I did it gradual but I think dropping by 1/2mg would have been better because I had a flare up and my phlebitus came back my leg still looks a mess and I have anti- biotics for if it gets inflamed again I asked doc if he thought it was because i had reduced my pred and he said no but I think there was a connection

[PMRpro Ambassador in reply to northants]

And pred doesn't reduce inflammation in the phlebitis?

PMR and GCA - or rather the underlying autoimmune disorder that causes them - does damage the blood vessels and make us at greater risk of venous embolism. Someone else has posted today - in hospital with a pulmonary embolism! And someone on another forum last week had just had a PE.

Until I looked last week I didn't know the statistics of increased risk with GCA - it hasn't appeared in any of the literature I have read before. BUT the BSR recommendations DO recommend GCA patients take low dose aspirin. That is better than nothing but not as good as proper anticoagulation (by a factor of 1.5) .

So if you are breathless or have chest pain - do get it checked out.

[piglette in reply to PMRpro]

The vascular surgeon gave me the impression that steroids do help as he said he sometimes uses large doses and steroids are of course good for inflammation. Perhaps as the dose decreases for PMR it does not help so much.

[piglette]

I wish I could just have anti biotics and not an operation. The vascular surgeon said it was 97% effective though which sounds reasonably hopeful.

[Manxlady]

I have suffered phlebitis after every birth ,three in all,and after having my veins operated on. Later on suffered P.M.R.strange thing I was talking to my daughter a trained nurse only the other day wondering if there could be a link. All good wishes!!

[piglette in reply to Manxlady]

I was wondering if there was a link too, as phlebitis means inflamed vein.