Relationship between blood markers for inflammation and being on an NSAID?

[MJJ7960]

I don't remember seeing this discussed: When finally diagnosed with PMR, I had been on a low dose of an NSAID for several years. Is it possible that might have been the reason blood work (ESR and CRP) was within normal ranges. No longer on the NSAID since beginning prednisolone.

[PMRpro Ambassador]

As I understand it, NSAIDs have two levels of effect: pain relief and an antiinflammatory action. Pain relief is achieved at a far lower dose than is required for the antiinflammatory effect. From what I can see in the literature, it probably depends on the cause of the inflammation, what substances are involved.

One study suggests that NSAIDs used continuously at a higher dose can result in a reduction of the CRP in some forms of arthritis and also result in some disease modification - i.e. for example, in RA there is less joint damage. NSAIDs tend to accumulate in the synovial fluid in the joints so that is possibly how they achieve that effect - the amount of NSAID in the joint fluid can be higher than the that found in the blood. PMR is a bit different in that most of the inflammation is found in muscles, even though some people do develop bursitis, so the effect in the joint fluid wouldn't matter as much.

I had PMR for over 5 years before diagnosis - not recognised or looked for because I never had raised ESR or CRP values, they remained stubbornly at single figures, very low, not even high normal. I occasionally took ibuprofen when the pain got too bad - but it never did more than take the edge off even though I use ibuprofen the way the manufacturers intended: you take a flooding dose of 800mg to start with and then top up every 4 hours with 400mg whereas OTC packs just quote a lower dose. Most people find NSAIDs don't do much in PMR and it never helped the stiffness at all for me. So my acute phase reactants (posh name for ESR and CRP) weren't low because I'd taken NSAIDs at a highish dose on a regular basis.

I suppose it depends - but I don't think you could say that's why your blood levels were low.

[MJJ7960 in reply to PMRpro]

Thanks for the thoughtful reply, PMRPro. Who knows. But thankfully the diagnosis for me was done before too many months of pain. As my GP says, we will treat the symptoms, not the test results.

[PMRpro Ambassador in reply to MJJ7960]

You are a lucky patient - if only more GPs were like that!

[Annodomini]

I had been taking Diclofenac for years usually at half the maximum dose, before I was diagnosed with PMR; and my inflammatory markers were sky high.

[MJJ7960 in reply to Annodomini]

Annodomini, thanks for sharing your experience.