Exercise Induced Vasculitis

[Gc2596]

I am just 6 months into my Prednisolone journey and learning, mostly from this forum, all the time. Not withstanding the obvious pain/ache relief it brings I have actually found a 'bonus side effect '. Not many of them eh! For many years I have suffered from Exercise Induced Vasculitis (also commonly known as Golfers Vasculitis). This is an inflammation of the blood vessels, in the lower leg, resulting in an unsightly red 'rash'. A good walk is a big part of my life, though proceeding with care now. Mainly happens in warm weather but wearing gaiters in winter can also cause it. Yet another 'condition' that occurs in the over 50s and more so in women. However, until I lowered to 5mg it never occurred (currently back to 10mg). I call them my 'Pred Legs' now! My friend and myself used to swap photos to see whose legs looked the most vibrant red. Although I'm sure she isn't jealous of my PMR! So, at the moment I'll take this 'side effect', along with the Osteoarthritis in my fingers not troubling me as much, but perhaps feel better when both return as then my PMR going in the right direction 🤞 Perhaps others have experienced this scenario?

[123-go]

Hello, Gc2596.

I’m not at all sure that Exercise Induced Vasculitis is a side effect of Polymyalgia Rheumatica or perhaps I should say that I haven’t heard of it in this context. How do you explain the connection if you’ve had EIV for a number of years but are only six months into your PMR journey? In any case, I sympathise: it all sounds most uncomfortable ☹️.

[Gc2596 in reply to 123-go]

Hello 123-go. Perhaps I didn't explain clearly but it's taking the Prednisolone, an anti inflammatory steroid, that has reduced the inflammation that causes EIV. Hence a welcome side effect!

[123-go in reply to Gc2596]

Thank you for the explanation… should have paid more attention to what you’d written. I took prednisolone for PMR for six years (now in remission) and I do know that Prednisolone is an anti-inflammatory medication 🙂. I’m pleased to hear you have moderated your favoured form of exercise to avoid relapse.

[AmbientB]

Hi

Very interesting as I'm in the same position. I was prone to exercise vasculitis prior to PMR and it mostly occurred after a longer walk in hotter weather. Looking back on it I tend to think of it has an early warning sign that I was a candidate for PMR - PMR itself being a type of vasculitis. Since being on steroids it hasn't happened, and the few long-lasting pigment patches from the iron in the blood also disappeared from my legs. But also changed my exercise habits from one 60 minute walk a day to 2 x 20 minute walks to limit the stress I put on the muscles. So I am not sure whether it's just a more cautious approach that has eliminated the EIV.

[Gc2596 in reply to AmbientB]

Enjoy your walking. I think I'd melt walking in temperatures you must encounter! Hadn't considered EIV a precursor as had for many years but can understand your perspective. I am convinced mine was triggered as a result of a heavy fall and manifested 2 weeks later. It does appear "bodily injury" is one of the possibilities.

[AmbientB in reply to Gc2596]

Mine was actually triggered by the flu vaccine in 2023 (confirmed by rheumatologist as the trigger), but I think several things like the EIV ahead of that were pointing to being at risk of eventually developing PMR, as well as genetic make-up. I also had high ferrite levels at the time that the GP could find no reason for (not diet or genetics) and I have since read in the PMR research that high ferrite levels are associated with increasing inflammation in the body. There was one study that suggested that ferrite levels could potentially be an early warning sign of PMR developing but it wasn't very in-depth as I recall.

[PMRpro Ambassador in reply to AmbientB]

"confirmed by rheumatologist as the trigger" - while it very possibly was, it wasn't the only factor and he couldn't know. Correlation is NOT causation!! The inflammatory marker is ferritin - and mine was actually the only raised marker I had,

[AmbientB in reply to PMRpro]

I did think I had made it clear it wasn't the only factor but it was the trigger. The PMR is itself was very rapid onset that complete floored me within 24 hours of the flu vaccination, with blood tests showing CRP escalating daily (eventually rising to 180) while having numerous other tests to rule out all more serious illneses as responsible. There was no sickness or illness prior to the onset, never contracted Covid, had all the Covid shots without issue (am not anti-vax in anyway whatsoever), and no other medical issues at all. But in the past as I previously suggested there may have been some early warning signs that I was susceptible to developing PMR (e.g. I didn't know about susceptibility of certain genetic nor the ferritin levels being indicative of inflammation). Certainly correlation is not causation, but the link to the flu vaccination (for some) has been written about in the PMR research and in my case the rheumatologist - after a very thorough investigation - thought it an entirely reasonable conclusion. I am sorry this has made you unhappy. I don't understand why.

[PMRpro Ambassador in reply to AmbientB]

Often I comment to clarify something - I'm sorry it has upset you, It certainly hasn't upset me, but it was "the rheumy confirmed ..." comment that resulted in my comment. He couldn't CONFIRM anything,

[PMRpro Ambassador]

Never heard anyone comment on it before - but a few people have had unrecognised benefits from taking pred and only found out when they stopped!

What do you mean by gaiters? Just curious ...

[Miserere in reply to PMRpro]

I would think waterproof gaiters that cover the top of the boot and the bottom of waterproof trousers - useful things.

[Gc2596 in reply to PMRpro]

Miserere has provided a perfect description. Yes, great for protecting top of walking boots and bottoms of trousers. A staple piece of 'equipment' for most walkers. However, the extra layer they provide and being waterproof creates even more warmth in the lower leg and hence aggravates EIV even more so. I've tried that many different walking socks, (fibres/length), in an attempt to keep cooler with varying results but nothing, until Prednisolone 😁, work well. I could stock a sock shop!