Referral to Rheumy

[Annodomini]

After almost four years on varying doses of pred (now 10mg) and see-sawing inflammatory markers, my GP has decided to send me to a rheumatologist at Macclesfield Hospital to see if there is any other underlying auto-immune condition causing the markers to stay higher than expected although after a few months they were down almost to normal. He mentioned scleroderma because he had noticed some tiny white marks above my top lip. It took a powerful magnifying mirror for me to see what he meant. He must have amazing eyesight!

Does anyone know anything about this condition? And does anyone know anything about the rheumies at Macclesfield?

[PMRpro Ambassador]

nhs.uk/conditions/scleroder...

I had to google it to check because I was sitting there wondering how you might confuse PMR symptoms with scleroderma. At any stage. I have to say - I don't think I am any the wiser.

He doesn't think the varying doses of pred and see-sawing blood markers could be connected then?

I'm feeling more like Victor Meldrew every day - I was told a rheumy claimed if you can still walk it can't be PMR that you have. To go with "PMR isn't painful".

[Annodomini in reply to PMRpro]

I don't think there was any doubt about the original PMR diagnosis - it was a perfect fit in every respect sky-high CRP and ESR plus immediate response to pred. What he suspects is that there is another auto-immune condition as well. He has certainly never claimed that PMR isn't painful!

I usually have great respect for this GP's diagnistic capabilities, so will just wait and see what the rheumy says. Appointment is yet to come through.

[PMRpro Ambassador in reply to Annodomini]

Yes - but I'm surprised scleroderma got a mention - since if it were bad enough to need more treatment I'd have expected you to be complaining more of Reynaud's and the skin changes. It just seemed a strange choice.

I shall be very interested to hear how you get on though. No-one is particularly bothered here about me still having PMR after 10 years and symptoms returning if I try to go lower than 4mg. Blood markers don't count - ESR never went above 7!

[Annodomini]

At the moment my CRP is 22 and ESR 27. CRP has gone down from 35 and ESR up from 25. Initial CRP was over 200 and eventually went down to 14. I told him I thought that various infections since November accounted for some of these results. However, he seems to be puzzled.

[PMRpro Ambassador in reply to Annodomini]

CRP is known to rise in chest infections - anything up to 60+. And really - readings of 25 and 27 for ESR are within expected variation. It's a biological test - not an engineering one.

There is a generation of medics who are totally fixated on numbers - but it doesn't always work in medicine.

[Celtic PMRGCAuk volunteer]

Anno, I'm surprised that your Dr is "puzzled" by the CRP and ESR results when he obviously knows you've been suffering from various infections recently. It is well known that the markers will rise when something else like a virus or infection is going on. Although your CRP is rather high, your ESR is not unduly so. If your PMR symptoms are not bothersome, then there could, of course, be something else going on to cause an increase in the CRP. However, I would want to have the blood tests repeated once recovered from all the infections before getting unduly worried.

[Annodomini]

Thanks Celtic. I did hold off for a couple of weeks after I got rid of the flu, but perhaps this wasn't long enough. Now I can't shake off the stuffy head and might have a residual sinus infection. If it's still no better by the end of the week I will be on to the surgery again.