Leg Claudication

[phebamom]

Does anyone else have issues with leg pain when walking. I am trying to walk a mile a day and always have leg pain. I suspect peripheral artery disease. Is Peripheral artery disease a part of GCA/PMR?

[PMRpro Ambassador]

There is an increased risk longterm.

You say you always have leg pain - where and how does it manifest? Claudication is defined as pain that starts, usually in the calves, after walking for a short time, worse if you try to walk faster or up a hill. and which then improves when you stop to rest only to start again when you take up the activity again.

[phebamom in reply to PMRpro]

You described it well. When I walk, in the calves.

[PMRpro Ambassador in reply to phebamom]

How far can you walk?

Tell your GP you need to be referred to the vascular medicine/surgery team for assessment. There is more than one cause and various things that are done. The first approach which you can start with now is to walk through the pain as much as you can before stopping. By doing that it will encourage new blood vessels to form which will bypass the blocked arteries and supply the muscles.

[Dochaz]

I have the same thing. I find walking through the pain works. I just slow down on hills, take smaller strides and after a while the pain seems to recede.

[phebamom]

I already had a vein ultrasound. I see the vein doctor the end of the month. I am curious as to whether or not this is PMR/GCA, or just genetics. My mother had an unhealed leg ulcer for 17 years. Then again, I am now haunted by the prospect that my mother may have suffered from this illness without a diagnosis. She died age 65 from colon cancer.

[PMRpro Ambassador in reply to phebamom]

Claudication is nothing to do with veins - it is the arteries being unable to cope with the blood flow required to supply oxygen to working muscle. Leg ulcers can be due to arterial or venous compromise - in your case you need a full investigation.

healthline.com/health/arter....

[phebamom in reply to PMRpro]

My poor mother. I think she had this, and it was never identified. I will continue my daily mile walk. Although I read where a 3 times daily walk is better. I just don't have that much steam. I will discuss all of this with the vein doctor when I see him at the end of the month. I am on Actemra, and at this point can no longer increase prednisone dose. At 5mg. and need to stay there if I can. 13 years of Prednisone is just a long time. My rheumy wants to avoid the high doses if possible.

[PMRpro Ambassador in reply to phebamom]

Tell me about - 13 years here too, but a lot of it at over 10mg. But it kept me functional when it mattered and hasn't done too much damage we can identify .

[phebamom in reply to PMRpro]

I did something interesting. I checked my o2 stats prior to walking; 99. After walking it was 96. So, obviously I am not getting enough oxygen. I also have a hard time breathing in the morning. When I walk in the evening this does not happen as much. I am also being tested for sleep apnea. I am wondering if swelling in my larynx in the morning is an additional cause on top of the GCA. I plan to try a hit of albuterol inhaler tomorrow morning and see if that helps. Will test o2 again and see. will post results.

[Rugger]

As PMRpro says, you need this investigated and do discuss it with your doctor at the end of the month. I had similar symptoms and a PET-CT scan showed that my arteries were affected by the GCA. GCA-LVV (Large vessel vasculitis). An increase in pred and 2 years on Actemra seem to have got on top of the problem for me.

Best wishes to you.

[Blossom20]

Yes, I have it too! I've just posted about it and included an article which says that Pred can cause it.Mine started about a year into PMR and has got steadily worse. I was fit and active when I started this. I'm waiting for an ultrasound scan. I'm so worried about it.

I'm not overweight (well a bit!), I eat well, and exercise still, even with the pain. I have to use my bike to get to places now because I can't walk properly! I can ride a bike and walk up stairs but I can't walk without stopping frequently.

I'm so scared of having to go on statins and goodness knows what else.

[PMRpro Ambassador in reply to Blossom20]

I don't think it says pred CAUSES PVD - it increases the risk of getting it. That isn't the same. I've been on pred for 13 years - and no sign of PVD. Many people develop it without ever having been on pred.

[Blossom20 in reply to PMRpro]

No, sorry, it says it increases the risk.I was interested that you said to push through the pain as that increases new blood vessels. I was late for work yesterday and had to push through it, but was worried - it felt like I was going to tear a muscle! Good to hear that though and it does make sense.

[artfingers]

Interestingly, I had a half body ultrasound scan (it slid me into this big machine) but they did the neck, chest, organs, stopped at pelvis but did NOT do my legs though I was complaining about pain in my legs after walking about a mile or two or climbing. My new rheumy said it did not show large cell vasculitis (she was checking for GCA) so I guess that is good. But I was trying to explain to her that it felt like my calves were being squeezed of oxygen (not getting enough) somehow. Next time I see her I'll ask for a work up on the legs this time.

[PMRpro Ambassador in reply to artfingers]

My mind is boggling? What machine can do ultrasound in a tube scanner - it is a directional technique using a transducer. And NO scan would show giant cells - that needs histology. Whatever it was would show inflammation - that MIGHT be due to giant cells but there are other causes.

[phebamom in reply to PMRpro]

I thought the only machine that could detect inflammation is a PET scan. Here in the US a PET scan is very expensive and rarely covered fully by insurance. I have great insurance and my PET scan 5 years ago cost me over twelve hundred dollars. Am I wrong? Will a CT scan or MRI show inflammation?

[PMRpro Ambassador in reply to phebamom]

Depends on the type of inflammation and whether there are structural changes due to the inflammation I think,

This very new stuff:

health.ucdavis.edu/news/hea...

The PET scan is good because you would get inflammation in all sorts of tissue showing up - and it is the position of the inflammation that differs bewteen various a/i disorders

I googled what scans can detect inflammation - but it would take all day to do all the links explaining what shows what ...

[artfingers in reply to PMRpro]

Oops, sorry! It was a CT angiogram. CT Aorta Complete - DetailsImpression

IMPRESSION:

1. Normal diameter thoracoabdominal aorta and branch vessels with no

atherosclerotic calcification, and no wall thickening to indicate

vasculitis.

(and some other things like showed gallstones)...

[PMRpro Ambassador in reply to artfingers]

Yes - that makes more sense. Sounds good. Well, apart from the gallstones!!!!

I had a carotid scan recently - all fine she said. Which I think surprised her as she was all tied up in knots about my cholesterol level and insisted on statins. Which promptly caused a PMR flare.

[phebamom in reply to PMRpro]

I refuse to take statins. They are shown to not work well with women, and with men there is only a 12 percent of preventing a second heart attack. My cholesterol level is high. that is a side-effect of Actemra. Cholesterol shot up after I started on Actemra. That makes more sense concerning the test. I had a PET scan to look for inflammation or tumors. They found nothing at the time. That was 2017.

[PMRpro Ambassador in reply to phebamom]

Quite - and I won the argument with my usual cardiologist but when I needed an appointment because of a non-cardio qualified arrogant ward doctor I saw the other - and she got quite stroppy. So I agreed to try a different one for peace. Lord knows what will happen when the Actemra takes effect!

[nallufl24 in reply to phebamom]

My cholesterol went sky high after I started Actemra. Statins cause me severe muscle pain so my doctor started me on a drug called Rapatha which is not a statin. It brought my cholesterol down in 2 months. Only problem is it’s very expensive and my insurance will only pay half but I have no choice right now

[tangocharlie in reply to phebamom]

Somewhere I've read that the latest thinking is that cholesterol might actually be good and have a protective effect, and our bodies actually need and thrive on fats. I'll try and find where I read it but have brain fog today

[marionofnorwich in reply to tangocharlie]

Yes, but surely HDL and not LDL cholesterol. HDL is protective, LDL isn't.. It is true that we need fats but it again, depends on which eg olive oil good, beef dripping bad! Eggs are no longer evil though apparently

[PMRpro Ambassador in reply to marionofnorwich]

There is even dispute as to whether HDL is really as "protective" as was thought,

[phebamom in reply to marionofnorwich]

Several years ago I found this book at a local book fair: amazon.com/Fats-That-Heal-K... The book changed the way I viewed fat and all the histrionics over cholesterol. At times the book is a hard read, it digs into the chemical aspects of fats and how the fatty acid chains are built and work. The book is a must read.

[tangocharlie]

I have ' concrete legs' and have done all along with PMR. It also seems part responsive to and improved by steroids. I was recently referred to a vascular clinic for tests aand have been told the valves in my lower legs aren't pumping bood efficiently. Told to wear support stockings but they don't seem to help. Apparently there are loads of reasons these pumps stop working including age. I'd ask for similar tests, might give you more information? or in my case, I'm still not sure.

[phebamom in reply to tangocharlie]

Actemra has helped me some in that regard, but part is just age and hereditary. My mother had a leg ulcer on her right ankle, the size of a quarter, for 17 years. Today I am being fitted with a pump system that I put on both legs in the evening while I watch tv. That pump, along with my stockings, which I have been wearing for a year, are helping. I no longer have horrible leg and ankle cramps. My walking has improved. Here is what I am doing: Knee length stockings, good ones, core-spun, 20-30- pressure. I buy Therafirm brand. They are pricy, but they last well if you don't put them in the dryer. Every day for a couple of hours I sit down to rest in the afternoon. I remove the stockings, prop my legs up on my recliner and slather my lower legs with lotion, per therapist's instructions. Hydrochoorathiazide, 25 mg. per day. (water pill). I have lost at least 10 extra pounds of water weight, blood pressure finally going down, headaches going away, able to bend my left knee for first time in weeks.

[marionofnorwich]

Yes, I have had what I would describe as claudication in my calves but can no longer test it out as I have a fractured knee (femur) now which makes walking anywhere difficult though, like you I can cycle, thank goodness as it would be hard to get anywhere otherwise

[marionofnorwich]

Stress fracture I should say not an impact break