Background/Purpose: In a previous cross-sectional questionnaire survey, we had shown that intermittent claudication was significantly more common among BS patients when compared to healthy controls, and had proposed that this was a “venous claudication” (1) rather than due to atherosclerotic vascular disease since  a. a history of myocardial infarction or angina pectoris were not increased in frequency in the same group of patients as compared to age and sex matched healthy controls; and b. this  intermittent claudication was specifically more common among males with venous thrombosis. The so called venous claudication is thought to be an exercise induced pain resulting from venous outflow impairment (1).  With this study we aimed to 1. To reassess the frequency of venous claudication by a questionnaire survey and 2. To further study this venous claudication prospectively by a formal treadmill exercise in BS patients with and without venous thrombosis along with healthy controls. 

Methods: We studied 59 BS patients with lower extremity venous thrombosis (LEVT), 42 BS patients without venous disease and 55 healthy controls. All patients and controls were male. Patients and controls with peripheral arterial disease were excluded. Intermittent claudication was assessed initially by Rose questionnaire. After this, patients were asked to walk in the treadmill at a set speed of 3.5 km/h and 10% inclination for 10 minutes. Patients who first experienced persistent symptoms consistent with venous claudication but still able to walk and those who had to give up the treadmill were noted. Pre and post-exercise ankle brachial pressure indices (ABPIs) were also measured.

Results: The mean ages of the patients and controls were similar (Table). Pre and post-exercise ABPIs did not differ between patients and controls. There were significantly more patients who described claudication in the questionnaire among those with LEVT (31 %) compared to those with no venous disease (5 %) and healthy controls (0 %) (P<0.001) (Table). Similarly, the number of patients who experienced claudication but still continued to walk on the treadmill were significantly more among those with LEVT. Finally, only those with LEVT had to stop the treadmill challenge due to claudication.  Pre and post exercise ABPI’s were similar among BS patients with LEVT. There was no relation between the presence of vena cava, iliac or femoral vein involvement and the presence of claudication or limitation of walking capacity.

Conclusion: Venous claudication seems to be a severe and frequent symptom being present in up to 1/3 of BS patients with major vein involvement. It clearly limits the walking capacity in 10 % of these patients even when tested in a treadmill set at low pace. 

References: 1) Ugurlu S, et al.. Rheumatology (Oxford). 2008;47:472-5.

Table: Severity and frequency of claudication

	BS patients with venous thrombosis n = 59	BS patients without thrombosis             n= 42	Healthy controls  n = 55	p
Age, mean ± SD, years	37 ± 7	34 ± 7	36 ± 9	0.346
Claudication as assessed by questionnaire, n (%)	18 (31)	2 (5)	0	<0.001
Leg pain during the treadmill exercise (the patient continues to walk)  n (%)	10 (17)	3 (7)	1 (2)	0.016
Claudication necessating the termination of the  treadmill exercise, n (%)	6 (10)	0	0	0.006

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/venous-claudication-is-a-severe-and-frequent-symptom-in-behcets-syndrome/