I feel fantastic but ...

[piglette]

my GP has just phoned in a panic to say that my CRP has increased from 5 to 40 and my ESR from 33 to 52 when I had a blood test a couple of days ago against my previous test a couple of months ago. I have had a nasty cold recently, but otherwise I have really not had much pain from the PMR and am feeling really good. I have been away over Christmas having a whoopee time, perhaps too whoopee! I am currently on 12mg of pred and my GP wants me to increase to 15mg, but as the PMR pain seems under control it seems a bit unecessary. What should I do?

[PMRpro Ambassador]

I think the experts feel that pred shouldn't be increased on the basis of a single set of raised blood tests.

ESR certainly can be raised from a bad cold, and so can the CRP in an untreated respiratory infection: ncbi.nlm.nih.gov/pmc/articl...

Your GP should check them again next week once your cold has improved and see what they do.

[piglette in reply to PMRpro]

Thanks so much PMRpro. The authors seem to say CRP can happily go up to 60 with an untreated respiratory problem and I seem to fall into their test category. I think I will stay at the current dose of pred. I had tried to move from my current GP and saw a different one last week, but the old one seems to be hanging in there. She suggested I had an appointment with her and also should see a rheumatologist. I said what what about another blood test!! She really is hopeless.

[PMRpro Ambassador in reply to piglette]

I'm sure the rheumatologist would be hugely delighted at having his clinic filled with people on the basis of one blood test taken during an infection when the patient had no PMR/GCA-type problems and reported themselves "Well"

[piglette in reply to PMRpro]

I think she is protecting herself as she hasn't a clue. Perhaps she has not been taught about patients who say I feel fine and the drugs are working well!

[DorsetLady PMRGCAuk volunteer]

Hi piglette,

Would agree with PMRPro, one set of raised figures could well be related to cold not PMR. My GP, one of the wiser ones, always maintains there are many other factors that cause raised ESR, CRP readings. He thinks that the main factor for increasing steroids is how you feel yourself, you know if it is a "PMR" type pain better than a random test. Suggest you monitor things and if no pains then stay as you are until you have another test or talk to GP. DorsetLady

[piglette in reply to DorsetLady]

Thanks DorsetLady. My GP has only been a GP for six or seven months. I think she has been reading up on PMR, but still has a few gaps in her knowledge. I am not sure I want to stay around as her guinea pig though.

[PMRpro Ambassador in reply to piglette]

Pass on your knowledge then! I know, easier said than done but maybe hand her a copy of the abstract for reading before filing?

Once upon a time in the health care system you were told "NEVER run" . Masterly inactivity is often the watchword...

[Richard2012]

Hi Piglet,

In December I too had a jump in my ESR to 48 - approximately a three times rise. On a routine visit to my doctor he asked how I felt and I did feel good especially having improved over the few previous weeks - feeling better and with more energy. I had expected to drop from 5mg of Prednisolone to 4mg. The rise in ESR was a surprise to me. We agreed that I would remain on 5mg but if I became worse I could bump the dose up to 6 or 7mg. I have remained on 5mg and will see my doctor next week. I would be very surprised if the ESR has remained high as I still feel good. The point I am making is that how a patient feels is a valid part of the picture. An increase in ESR could be due to a transient condition such as a cold or other minor condition. I hope that by the time you read this you will have your new results for the ESR test and you will also still be feeling buoyant. Happy New Year.

Richard

[piglette in reply to Richard2012]

Hi Richard

I think you have got it spot on. My CRP and ESR seem to be very volatile to changes while some people's just stay stolidly the same. PMPpro's article says that in a trial people with untreated respiratory infections in the first few days could have a leap in CRP, which was my case with a bad cold. My next blood test is not until the end of January now. It will be interesting to hear how your next readings go.

[Richard2012 in reply to piglette]

Hi Piglette,

You asked me to let you know about how I got on with my visit to my doctor today. Lots of good news. Firstly my ESR had dropped - in fact halved. My doctor suggested that I now drop to 4mg per day of Prednisolone and hold it there for one month. Then for me to drop it to 3mg per day for the next month this being at my own discretion and provided that I continue to feel good. Therefore, my next ESR sample and test result/doctor visit will be in two months time. I asked him about the ESR spike and he confirmed that it could have been caused by a minor malady such as a common cold.

I hope that you also have continued to do well and that you have a helpful and cooperative doctor such as mine.

Very best wishes to you for a steady and full recovery.

Richard

[piglette in reply to Richard2012]

Hi Richard

That is wonderful news. I have managed to book a blood test for the week after next and will see what the results are. I have not bothered to book an appointment with my GP though, she just stresses me out, I will wait and see the results first.