GCA Flare & Lower Extremity Vasculitis?

[gifford7]

My GCA has been in remission for a couple years using maintenance 1 mg prednisone. In latter months of 2021 my weight dropped 12 lb, fatigue increased

and CRP & ESR showed modest increases from my normal CRP of 3 mg/L & ESR

of 12. and i started getting ulcer sores on lower legs. I tried reducing the pred to

0.5 mg and ulcers got worse and now blisters appeared to 3" size with swelling. My CRP rose to 8.9 mg/L & ESR rose to 20, so increased the prednisone to 5 mg/day, saw my rheumy who confirmed the GCA flare, and wound care from the vascular surgery PT. After 2 weeks my CRP dropped back to 3.4 mg/L & ESR to 12 confirming the GCA flare diagnosis. My rheumy thinks the lower leg problem is venous stasis and little to do with GCA. However the Mayo Clinic published an article connecting the GCA flare to Lower Extremity Vasculitis

"Lower Extremity Vasculitis in Polymyalgia Rheumatica and Giant Cell Arteritis

Tanaz A. Kermani, MD and Kenneth J. Warrington, MD

Division of Rheumatology, Department of Medicine, Mayo Clinic

Recent findings—Imaging studies in GCA and polymyalgia rheumatica (PMR) suggest that vasculitis can affect multiple vascular territories including the lower extremities (LE). The findings of imaging studies, clinical features and outcomes of patients with LE vasculitis are explored in this review. Possible mechanisms for the observed distribution of vessel involvement are discussed,"

ncbi.nlm.nih.gov/pmc/articl...

Next the vascular PT will replace the leg wrappings with compression sox.

Ultrasound tests next month for DVT, Continuing 5 mg pred for around 6 weeks

and taper pred to 2-4 mg. THE QUESTION BEING IS THIS VASCULITIS OF LEGS.

[PMRpro Ambassador]

Not something we could say yeah or nay to - that is up to your vascular specialist to have a look.

If they are doing u/s next month they should be able to see a lot.

This

pubmed.ncbi.nlm.nih.gov/338...

suggests to me that if the CRP was raised and you don't have any infection of the venous ulcers, then it was due to inflammation which would fit with it being a flare of the GCA and POSSIBLY the local vessels are involved - but the poor blood flow COULD be due to GCA affecting other arteries.

[karegodd]

Interesting article. Thank you. I’ve had PMR since 2017 and can’t get down in prednisone and MTX. Interesting enough I’ve had a DVT in the calf which went onto 4 pulmonary emboli pre PMR. There has to be some kind of connection which hopefully science will be able to connect the dots in time. My dad also had abdominal aortic aneurysm plus two more I to the pelvis and third into the femoral arteries. All required surgery. Could their be a familial connection? My thoughts would be yes.

Again thanks for sharing the article

[rustirose]

I so appreciate your including the link to the paper. I too have developed symptoms in my lower extremities shortly after my PMR/GCA diagnosis and my rheumie keeps telling me that what's happening in the lower extremities can't possibly have any relationship to GCA/PRM and isn't including those lower extremity symptoms as he determines corticosteroid dosing and taper. I'm going to forward this article to him to facilitate a better discussion with him. Thank you so much!

[nallufl24]

That’s interesting. I had severe lower leg pain and swelling about 2 months ago. I could barely walk. When I talked to the doctor, of course he said it was not related to GCA or Actemra or pred. I got an ultrasound because I thought it might be a blood clot. It wasn’t. Anyway my regular doctor said I needed to go to a vascular doctor. My appt is in April, however, the pain and swelling has gone