Blood tests

[northants]

Does anyone know much about the blood tests we have when we have PMR? dr says he is quite happy with mine at the moment but never really explains anything thank goodness for this website

[piglette]

I have had fourteen blood tests since being diagnosed with PMR about fourteen months ago. I ask for a print out every time I have them and have become a bit of a nerd doing spread sheets! I always have CRP and ESR to check the inflammation. I occassionally have a complete blood test, U & E and a glucose test. I have also had thyroid and RA tests once. I was also found with vit D deficiency so have had that tested a couple of times. I have also had a couple of blood platelet checks.

[Fracham]

You should ask for the CRP level and compare the latest readings to see if it is decreasing, I understand that the normal level is 6.

[northants in reply to Fracham]

The Doctor said mine is 14 and anything below 15 he is happy with. I am glad someone knows what the normal figure should be. I sometimes think I know more by using this website than doc I am on 9mg now and he wants me down to 8mg I said could I drop by half mg and he said no he wants me to drop by 1mg

[Celtic PMRGCAuk volunteer in reply to northants]

Northants, I've just seen your latest post after sending a reply. If you feel the need to reduce by half a mg, then follow your gut instinct. Only you know how you feel, not the GP who "wants" you to drop by 1mg. Few of us would ever recover if we followed some GP's advice. The inflammation of PMR has a mind of its own and will go away when it wants to and not when anyone else "wants" it to! I only succeeded in reducing from the 5mg level and getting off steroids after decreasing in half mg stages and tapering slowly taking seven weeks to reach each new dose.

[Jilldrog in reply to northants]

So true my dr just handed me a print off of a website on PMR but doesn't seem to have read it. I've learnt so much more on these forums.

[Celtic PMRGCAuk volunteer]

Northants, there are two blood tests that can be used to check inflammation levels in the body when certain illnesses are suspected, including autoimmune inflammatory conditions, infections, etc. One is the CRP (c-Reactive Protein) which checks for levels of protein in the blood which can be raised in such illnesses. The other is the ESR (Erithrocyte Sedimentation Rate) which measures the rate of fall of red blood cells in a test tube - the faster they fall, the higher the ESR.

Normal CRP is considered to be anywhere between 0 - 4.9, whilst normal ESR is 0-20 for women and 0-15 for men, with slightly more elevated 'normals' possible in the elderly.

These tests are often used as a diagnostic tool where PMR and/or GCA is suspected and after other illnesses have been ruled out.

However, not every patient with PMR/GCA presents with raised markers - round a quarter of sufferers can show normal results but still have these conditions. If your GP is telling you that he is happy with your blood tests at the moment, it probably means that you are someone who had raised markers at diagnosis, and these, along with your symptoms, can be used as a guide as you reduce the steroids. In my case, both these tests were repeated before any reduction and I always asked what the results were and recorded them. I'm sure your GP would be happy to give you a printout of your results - well he should be!

[Llanboidy]

I understand from my GP that the normal range for CRP is 0-10 and the normal range for ESR is 1-20. Also I think that the ESR rate is considered the more useful one in relation to PMR. I understand from this forum that symptoms are a better guide to what is going on than these figures but presumably the figures are useful especially if they are going down or up.

[PMRpro Ambassador in reply to Llanboidy]

There is a lot of dispute about the value of the ESR - it is very non-specific and many things can affect it, including any infection such as a UTI or a cold. The test must be done soon after the blood sample is taken or the results may be "off". CRP is less affected by extraneous things (how long the sample has been taken or how it was treated) but also rises in response to a lot of things. CRP can rise to 60 or more if you have a respiratory tract infection - so if it is raised during a cold it isn't a sign the PMR is worse and if you haven't got worse symptoms it is better to wait a week or two and check it.

There is some thought that if both CRP and ESR are raised in a patient with PMR symptoms then it is better confirmation it could be PMR. But in the end, neither of them confirm anything - they are just indicators that there is inflammation in the body. If they are "normal" when you are on pred that doesn't mean the PMR has gone away - it just means you are on a pred dose that is at least high enough to manage the PMR, it could also be too high of course. And for some people the levels falls with pred - but doesn't rise in a flare or takes a long time to rise in a flare. Doctors who take too much notice of them and insist they are the whole truth obviously don't know much clinical biochemistry!!

[Hidden]

How interesting, as I too have a GP who has never explained about the ESR and CRP tests. I wasn't aware that patients could ask for a print out of their results.

My PMR came out of the blue in December 2008 and I have been on Prenisilone ever since. In that time I have see-sawed from 20mg down to as little as 4mg. Due to a nasty flare up a few weeks ago, which affected my left leg hip and groin, (I couldn't pitch my foot to the ground, so was unable to walk) I was admitted to hospital and told I had Trochanteric bursitis! The pain was so bad nothing seemed to help so this week on the 24th of February I was referred to see a Rheumatologist for further examination. He told me after Xrays that I didn't have Trochanteric bursitis, so I had more Xrays, but his main concern was my medication. I have been on the steroid Prednisilone for 7 years too long in his estimation. He said I should have been advised on reducing the dose during this time and would be speaking to my GP. I'm waiting for a call to hear what the way forward will be with new medication. At the moment I feel I'm in limbo!