Inflammation bloods

[Elmo333]

Hi. I’m slightly confused. Im seropositive with positive Rh factor and anti CCP. My ESR and CRP have been consistently raised for 10 years despite being in MTX. My pain is less at the moment (still aching and fatigue but not severe pain) but my ESR is still consistently around 50 and CRP 25. I know these numbers are not through the roof but I’m just wondering whether it is bad for the body to be running high in the blood all of the time. I’m 35years old. Dr is always keen to increase or add meds but I don’t want to do that whilst I’m not in bad pain. I feel the mtx injections is controlling it fairly well. What do you think? Ps I know you’re not drs but many of you are well travelled in the RA world. Thanks

[nomoreheels]

It can depend on a few factors, some people's ESR & CRP run higher than others but as you're seropositive & if your Rheumy is suggesting to increase or start double therapy then I would either heed his advice or ask him to explain why he's keen to increase or add more meds. Keen could mean that's his way or has picked up (or you've told him) that you're not wanting to add more than you're already taking.

Do you have a sedentary lifestyle, smoke, overweight, have a relatively unhealthy diet or familially high inflammatory markers? If so then maybe you need to discuss these with your Rheumy, it could make more sense to him you having raised inflammatory markers & could make the difference in his consideration of treatment. If you can relate to any of the above reasons for higher than normal inflammation values then there are obviously some things you can do to help bring them down.

You say you're aching & fatigued, if you're well controlled you should have neither, although fatigue is subjective & we can still have some even when in remission. Pain is also subjective, we do tend to get used to pain & what we may think of as only a niggle may need attention. Maybe your Rheumy's of the opinion your "not in bad" pain can be eased &, given the chance, you could be on the way to remission if your meds are either tweaked or added to.

Unfortunately we do usually need to take a cocktail of meds in an effort to be well controlled, or reach the ultimate... remission. Unless it's really your 'normal' consistently high inflammation isn't good, particularly CRP, acute inflammation. It's indicative of disease activity even if you don't have pain it's inflammation that's there now. That can mean joint erosion, reduction in movement & joint destruction. Again, it needs to be determined if your inflammation levels are your normal though.

Have a think, do you feel you could improve on how you feel? If so talk it over with your Rheumy. If you're concerned about taking more meds then be assured many of us so, it's nothing unusual. I daren't tell you how many I I'm prescribed!

[oldtimer]

On the face of it, high levels of inflammation as suggested by your tests would indicate that your disease is not well controlled. And if you are still having aching and fatigue that also suggests less than good control. So it is understandable that the rheumatologist would like you to increase your medication. But it is your body and you have to take decisions yourself as to what level of side effects you can tolerate.

[NicolaP]

I understand that other factors can affect ESR and CRP levels and have been in a similar situation to yourself for the last couple of years since starting Biologics, yet felt a lot better and some joints have improved a lot. I was diagnosed with seropositive Anti-CCP RA in November 2010. My now retired Rheumi accepted this but still was insisting that it wasn't working and needed changing. I've been reluctant because I know it has improved considerably in spite of inflammation markers being regularly higher even than yours, and was worried about changing.

However, I was tested for Vitamin D deficiency before Christmas and it came back as severely deficient. This can from what I've read affect inflammation markers in the body and, having started supplementing with a sublingual spray in early January, I've found the inflammation markers have dropped two tests in a row (something that hasn't happened for some years without steroids) and by March was feeling a lot better. CRP dropped from 37 in November (it was 19 in September but in the 40s prior to that but I never felt personally it should be that high) to 18 in late January and 14 in mid March, ESR down from 60 in late January to 36 in mid March. I previously would find a drop in CRP would not reflect in ESR until the next set of bloods due to the lag by which time the CRP would be back up. My GP who runs the shared care with the Hospital has taken the opinion that this was my new normal because things had improved. I'm due bloods again the end of next week and wait to see if the pattern continues, with a second consultants appointment with my new Rheumi a week later. It will be interesting to see what happens. My personal view is that if the markers stay lower or drop further, I would like to stay on my current biologic for longer and see what happens.

I note you've posted previously about being diagnosed with Vitamin D deficiency, was this resolved because if not it could possibly be affecting your inflammation markers, as it appears to have been doing for mine.