Pain in calf muscle

[Hollybee21]

Since starting Methotrexate end October 2022 I have been very slowly reducing my Pred, I am presently coming down from 6.5 to 6 mgs. Over the last couple of weeks I have been having a pain I’m my right calf going to the outside of my knee when walking or coming down the stairs (fine going up so don’t think it’s the knee joint). Please tell me it’s not a flare as I am so thrilled to be coming down on my dose after 14 years of Pred. It doesn’t feel like PMR as I can turn over in bed with no pain, it’s just when I’m walking. 🙏🙏

[PMRpro Ambassador]

Not claudication pain??? What sort of pain? Cramo or sharp? Does it start soon after starting walking and go away when you stop?

[Hollybee21 in reply to PMRpro]

Yes, it does start when I start walking and stops when I’m sitting down. When I cross my legs I can feel an ache behind my knee on initial cross then it stops (weird or what). My legs also feel very heavy if I walk more than 30 yds or so 🤷‍♀️🤷‍♀️

[PMRpro Ambassador in reply to Hollybee21]

Have you spoken to your GP? It might be worth asking for them to check your ankle blood pressure levels and comparing them with the arm BP. Peripheral vascular disease is more common in patients with PMR/GCA so worth bearing in mind.

[Hollybee21 in reply to PMRpro]

Thank you. I will do that next week, thought it didn’t sound like a flare.

[Gaz227]

I only got down to 4 Mg of pred on MTX any lower and back to square one . I also get a lot of calf pain , I was a regular 5k park runner but unfortunately when I try and run now my calf’s seize up , I have massages on them but don’t seem to make any difference, I also get cramp in my toes a lot when I do yoga I have to take it really slow with my feet till the circulation gets going , still not sure if it’s connected to meds , PMR or SAPHO syndrome , if your consultant has any ideas I would appreciate to know their thoughts on the matter . 👍 good luck

[PMRpro Ambassador in reply to Gaz227]

Have YOU been checked for peripheral vascular disease? Calf cramping is typical of that.

[Gaz227 in reply to PMRpro]

no , they didn’t seem concerned when I told them but plan to pursue it next appointment when ever that is .

[Gaz227 in reply to PMRpro]

any idea how that is checked , is it a scan. ?

[PMRpro Ambassador in reply to Gaz227]

The first thing is checking ankle/foot pulses and taking BP in arm and lower leg to get what is called the A/B ratio (ankle/brachial ratio). If there are signs of reduced blood flow at the ankle you should be referred to the local Vascular unit for further tests although there may well be a local threshold for referral. Can you walk without calf claudication?

[Gaz227 in reply to PMRpro]

yes , walking isn’t an issue for me within reason , I made it up snowdon a couple years back . My calf genetics are pretty poor to be honest .

[Mota1]

I get calf pain when running. It stops when I slow to a walk or rest. The pain resembles the jaw claudication I had when diagnosed with GCA and comes in both legs. I am taking a rest from running (no problem with walking) and if the problem does not resolve itself will take PMR pro’s advice and try for a GP appointment.

[PMRpro Ambassador in reply to Mota1]

Stopping running won't stop the underlying problem - but keeping walking as much as you can will. The initial treatment suggested is to "walk through the pain" - keep walking as long as you can after the pain starts and keep trying to walk further. This will stimulate the development of new blood vessels called collateral circulation to supply the muscles with oxygen and nutrients and remove waste products - which are what cause the pain.

[Mota1 in reply to PMRpro]

Thanks for that. I can walk for several miles without any pain so will be happy to follow your advice. And I thought I would be running until I was 90!

[PMRpro Ambassador in reply to Mota1]

It is possible that if you tried slower running it might achieve enough effect to be able to continue. It is all about not enough blood supply because of furred up pipes! The collateral circulation won't be furred up.

[Mota1 in reply to PMRpro]

Thanks again. Slower running is definitely helpful as is walk/run intervals. I am really pleased to read your comment about walking through the pain. On rare occasions when I have suffered whilst walking, I have done just that, but always worried about causing more problems long term. Thank you once again for your time. It is really appreciated.

[PMRpro Ambassador in reply to Mota1]

My husband ran the vascular lab at a major Scottish hospital with a groundbreaking surgeon so I picked up a lot of background about management, Their first approach was always "walk through the pain" to push out their limits so no, no harm from it, only good. I think patients were upset at not being given a pill but to be honest the medication is probably as bad as the problem! You don't need them at present - and I suspect you can postpone worsening at this stage.

[Mayadill]

And keep the laptop off the legs. Probably no-one else is as thick as I was but I finally tracked my right leg being a little difficult back to changing from sitting at a desk to sitting on bed or settee, so much cosier in winter... Purchase of lap-desk not quite overnight cure but a good deal of it. Mitigating plea: it's only a little one, guv. (12")