ESR levels and infections

[cathie]

I thought people might be interested to hear about the impact of having a rather longstanding cold on my ESR levels. They have been around 30 for the last six months. I didnt have a cold or flu all the way through the winter, but since the beginning of June I've had a persistent cold which is on the way out. I also developed an itchy rash after starting injectable methotrexate so was on low mtxate levels too. Anyway the last time I went for a blood test my esr levels had gone up to 79 and I was having random flares - shoulder, elbow, knee, hands all over the place. A couple of weeks ago they were so bad that I phoned the hospital helpline and was told to take anti-inflammatories and pain killers. Interestingly the painkillers I had in the medicine cupboard expired in 2006, which gives you a good idea of how controlled my RA has been.

Anyway - good news this morning. I'm shaking off this cold and my ESR has gone down to 47. Still a way to go, but I think it confirmed that cold, inflammation, flares and high esrs go together.

Further, I talked to my doctor about methotrexate and antibiotics. She says that if they took people off mtxate every time they went on antibiotics it would be very confusing. I said that it seems that there's a different view for every practitioner and she agreed. The hospital had sent me a pro-forma saying that you should come off mtxate when you're taking antibiotics! My GP is also looking in to singles jags and mtxate. I know the pack drill about not being able to use live vaccines, she is looking at how long I might need to be off mtxate in order to get the jag. Both my parents suffered greatly from the after effects of shingles and my GP agreed that given that we're immunosuppressed we ought to have it if there's any way.

So bits of info I thought it would be useful to share.

[cathie]

Thanks I knew all that but really wanted to share the figures and experience with the others.

On shingles, there's the issue of it being a live vaccine and therefore unsuitable for people on immunosuppressants. That's the issue my doctors are investigating. I tend not to accept guidelines until I really understand the reasoning !

All best,c

[Hidden in reply to cathie]

That's all really interesting thanks Cathie. I haven't had any flare ups as such but since dropping a few doses of Metoject my ESR was up from 32 to 44 last month - still lower than yours but my GP was a bit concerned. I definitely notice inflammation in a systemic way and could have told her that my ESR was going up again. No cold or bugs but just a feeling of deep heat in my limbs and up my back and in my feet that seems to represent a rise in inflammation. Glad yours is on the way down again. I hope normal MTX levels can resume. I've never had to come off MTX for antibiotics - I think that advice from your hospital sounds a little to general and typically over cautious. As one who has changed doses and even been off MTX for a month a while ago I do think it plays havoc with us and the RA. So continuity is best where possible. My consultant always says this about not chopping and changing my meds for this reason. X

[Jennysteve in reply to Hidden]

Hi i'm new to the forum thing. But i noticed you talking about you ESR mine is very often in 60 to 80rangeit has never been lower than30 i get chest infections and end up on anti biotics.but i try and keep smiling.Hugs to all who are suffering today. x

[Hidden in reply to Jennysteve]

Hi Jennysteve and welcome. I don't know how new you are to RA but, depending on your age, 30 might be your normal range as it probably is for Cathie? The doctors here seem to have 0-10 as within normal range for everyone but actually the American College of Rheumatology counts remission at any ESR under 30 for women and under 20 for men - plus lack of swelling or pain. I did read in the BMJ once that for women you take your age, halve it and then add five to have your normal ESR. Tilda x

[cathie in reply to Jennysteve]

Hello jennysteve. Tildas right it does depend on your age for esr but it does show the general direction of inflammation so I find it handy to keep an eye on it. Hope you're ok at present

[cathie]

Yes, hospitals can be very dogmatic cant they. The Western general sent me a printed instruction sheet after I spoke to a nurse about my flare. It had 'do not take mtxate with antibiotics' highlighted in yellow! Good job I'm old and experienced enough not to be too bothered by dogma. I hope it helps people to hear about this and I'd say to always check with GP.

[Hidden in reply to cathie]

I think GPs are more trustworthy than hospital administrators are somehow- it's the one shoe fits all approach that really sucks isn't it? I suppose they are worried all the time about being sued - litigative society and all that. X

[cathie in reply to Hidden]

I think the instructions about mtxate was something the nurses were using / originating, I'll find out. But they're going to be awful cautious in this climate aren't they