I have just had my monthly blood test and my CRP is 20, when it is usually 1 or 2.

[Trenny]

I am on Prednisolone 12 mg daily (for GCA) and had got down to 10mg in March, but had a relapse with violent headache and vomiting, so had to up the dose. What might have caused the increased CRP? Could it possibly be the mild excitement of a rare visit from my daughter and a grand-daughter? It was hardly stressful, but I did walk further than my usual 20 or 30 minutes (twice). The Dr has suggested than I can increase the doseage or leave the dose unchanged unless i have any adverse symptons, and have another test in two weeks. I am leaving the dose unchanged unless I feel ill. Could the extra exercise affect the C Reactive Protein?

[Celtic PMRGCAuk volunteer]

Trenny,

The excitement of the family visit wouldn't cause a rise in the CRP as such, but the extra stress involved, including the sudden increased exercise, could possibly have caused an increase in your inflammation levels leading to a knock-on effect to the CRP.

In my experience, rising CRP would have alerted both my rheumatologist and me to a sign that my present steroid dose wasn't containing the inflammation of PMR/GCA and I would have been advised to increase the steroid dose until a repeat blood test showed an improvement in the markers - CRP is generally considered to be a reliable marker of inflammation.

As you mention having suffered a relapse just last month "with violent headache and vomiting", it does leave a bit of a question mark as to whether you are completely over that flare, and whether at the time you increased the dose sufficiently and for long enough to obtain/maintain overall control of the inflammation. The violent headache and vomiting to which you refer were among my symptoms at diagnosis of GCA. Do remain very alert to any sudden problem with your vision and seek immediate investigation, at A&E if in doubt.

[Trenny in reply to Celtic]

Celtic, Many thanks. I have an appointment with the Consultant next week, so will try to hang on until then before changing the dose. He should give me a blood test.

I am rather anxious about all this because we go away for (only) three nights the following week, but have a five hour train journey there and back. If the consultant increases the dose there will be four days for it to take effect which should be long enough, I hope.

[soojay]

Hear,hear,Celtic.........but on the other hand our bodies and hormones do not behave ,by nature in a consistent manner.I'm sure its just a little blip!Hugs Soo.

[PMRpro Ambassador]

The blood test must be repeated before saying it is really significant - I have had one single high CRP in 10 years and when repeated the following week it was back to its normal level. There are a lot of things that can be the cause of a single anomalous reading - including the wrong result being reported!

In the context of it really being raised the blood levels often lag behind the actual inflammation - so if the episode in March really was a GCA flare that could be the cause - but a bit of excitement and exercise shouldn't affect a CRP. The preference for CRP rather than ESR is that there are fewer things that will give a false effect because something that would go up with a family visit is pretty meaningless as an indicator.

[piglette]

After a flare last month my CRP went from 18 to 37 and I upped the pred. My ESR stuck solidly at 42 though. Another test next week when I hope it will reduce again.

[Trenny in reply to piglette]

What dose were you on, and how much did you increase your pred. by? How are you reducing it to the original? I am back to where I was in January - 12mg.

[piglette in reply to Trenny]

I was reducing from 20mg to 15mg and failed. I then went back to 20mg and started to reduce to 17.5mg over three weeks, which seemed to work OK. I am now trying to get down to 15mg again over four weeks. It seems to be going OK at the moment. My CRP was 123 originally when I started on pred.

[PMRpro Ambassador in reply to piglette]

Any reduction shouldn't be more than 10% of your current dose - trying to reduce 5mg at a time is far too fast and almost bound to cause problems. I reduce in 1mg steps and even the spread it over a few weeks - until I started doing this i couldn't get below 9mg, now I'm down to 5mg with no problems. Others have found the same. I have posted the scheme several times.

[piglette in reply to PMRpro]

Thanks PMpro. I am seeing the rheumatologist in two weeks when he wants me down to 15mg. I think he will then want me to reduce to 10mg. Should I stay on 15mg for a while and if I reduce can I use your reduction method to 10mg or should I try and reduce to say 12.5mg first? I only have 5mg tablets which makes reduction difficult in small amounts.

[PMRpro Ambassador in reply to piglette]

As I've said - I think the reduction your rheumy is aiming at is too fast. It is the sort of rate that works for other things where pred is used for but PMR doesn't seem to want to accept it! That he wants you to get to 15mg and lower is fair enough - but not in a 5mg step all at once. If you are on ordinary white uncoated tablets you can ask your GP to provide a 1mg prescription which will allow a slow reduction. I'm not sure - but I think my reduction scheme would work OK with 2.5mg steps if you really take it slowly - ie. don't start at 1 day new, 4 days old but start at the beginning of my version. Here's my version again:

My reductions are VERY slow. I use the following pattern to reduce each 1mg:

1 day new dose, 6 days old dose

1 day new dose, 5 days old dose

1 day new dose, 4 days old dose

1 day new dose, 3 days old dose

1 day new dose, 2 days old dose

1 day new dose, 1 day old dose

1 day old dose, 2 days new dose

1 day old dose, 3 days new dose

1 day old dose, 4 days new dose

1 day old dose, 5 days new dose

1 day old dose, 6 days new dose

By that stage if I feel OK I feel safe to go all new dose. I suppose you might be OK starting and stopping at "1 day new, 4 days old" but I was terribly sensitive to steroid withdrawal pain so I err on the safe side. Once you get to the "everyday new dose" - if you feel OK you can start on the next reduction, no real need to spend a month at the new dose.

But wait and see what he says before worrying about it. 15mg is the most commonly recommended starting dose for PMR - here it is just the jumps that are causing you problems I think.

[piglette in reply to PMRpro]

Thanks PMRpro that is really helpful. I must admit my rheumy does seem more interested in reducing the pred hell or high water than how I am with the PMR!! I am currently using 5mg pred coated prescribed by the rheumatologist.

[PMRpro Ambassador in reply to piglette]

Any reduction should be governed by the patient's CLINICAL status - i.e. the symptoms and how they feel. It says it in enough text books and review/research papers.

Enteric coated pred comes in 5mg and 2.5mg - and they MUSTN'T be cut. But 2.5mg at a time should work done slowly enough.

[Hidden]

I find it difficult to answer queries like these.

It would be helpful if when posting people put their details at the end of the post.

History. Diagnosed with and date. Started on ?mg. Now on mg.

Any other condition.

Me: GCA only for 5 years. In remission and off pred for 18 months.

[Trenny]

I saw the new 'Consultant' this morning and asked about my CRP=20 result. She says that I should ignore blood test results and go by 'symptoms'. She spoke with confidence (as they do) and says that blood tests aren't really necessary. She says that I may need to increase the Pred dose by up to 5mg if I get a relapse, but I must reduce the dose VERY slowly. I mentioned the regime on this site and she is happy to go with it. I am on 12.5 mg at the moment. She says that it may take up to two years to get off them. She has increased my Leflunamide/Arava from 30 mg to 60 mg daily to help towards this end. Not withstanding I think that my GP will be willing for an occasional blood test before my next appointment in 6 months!

[Trenny in reply to Trenny]

Correction! Arava increased from 10mg to 20mg - not as given!