ESR and CRP

[nuigini]

During my 20 month journey with PMR I have been tested for both ESR and CRP. Below are the readings over the past 12 months. First column is the dose of prednisone; second is the ESR/CRP readings respectively, and third is the date of the testing.

16.5 mg12/2.5Dec 4/14

16.5 mg13/3.5Jan 7/15

16 mg11/1.3Mar 20/15

15/14 mg11/6May 21/15

14.5/14 mg13/5July 7/15

12.5/12 mg7/22.3Oct 20/15

At the peak of PMR pain in March/14 the reading was 41/169.9.

Although I’m concerned about the elevated CRP this month, I really can’t say that my symptoms are any different than they’ve been over the previous 11 months. I have some return of bicep and triceps pain; however, I also recently got back to aqua exercising, which was stopped due to an unfortunate closure of the local pool for 8 months. Issues with my legs have been consistent and frustrating all along. Nothing has changed there. Hip and back issues have been dealt with by Bowen.

On the day of the test I had quite severe pain in my left shoulder. It resembled bursitis pain and settled down after a day or two on Tylenol and gentle exercising. It’s still a bit niggly, but getting better. Could this have caused the increase in CRP? Should I increase prednisone for a bit?

I have a new GP. He wasn’t concerned about the increase in CRP when I told him that I was in the early stages of a .5 drop to 12 mg. I didn’t think about the bursitis in my shoulder when we spoke.

Another question….my new GP has given me a standing lab requisition for all the required lab tests every three months. I only just notices that he will be monitoring CRP only, not ESR. Is this sufficient?

[PMRpro Ambassador]

You should never be tempted to increase the pred in response to a single raised reading of anything - it should always be checked, and even so, the symptoms are always trumps. If you have no symptoms there is no reason to increase the pred until there is evidence of a continuing trend of a rising marker. Even CRP, which is said to be less influenced by other factors than ESR, will shoot up if you have a chest infection or certain other sorts of inflammation. I had one single high CRP - something I'd never had in the history of my PMR - on a day when I obviously wasn't well when they took the blood sample and soon afterwards had a quite severe but unrecognised episode of atrial fibrillation. The following week it was back to its normal low level.

Some doctors feel CRP is a more accurate reflection of what is going on and it isn't affected by certain extrinsic factors so is possibly more reliable. ESR must be done within 4 hours of taking the blood sample or it may be inaccurate and if it is a long way to the lab that often can't be avoided. So not doing ESR shouldn't make any difference - and looking at those figures, as far as I can tell with the lack of spaces, your ESR didn't change significantly whereas the CRP did.

[nuigini in reply to PMRpro]

Thanks for the reply PMPro. You eased my worry and concern.

Sorry about the lack of spacing. There was spacing in my draft that somehow got lost in the act of posting.

[PMRpro Ambassador in reply to nuigini]

It's the forum, not you. You probably would have to put in dots to keep the space, I've had similar problems in the past.

[nuigini in reply to PMRpro]

Dots it is.

16.5 mg..........12/2.5..........Dec 4/14

16.5 mg..........13/3.5...........Jan 7/15

16 mg.............11/1.3...........Mar 20/15

15/14 mg........11/6..............May 21/15

14.5/14 mg.....13/5..............July 7/15

12.5/12 mg......7/22.3.........Oct 20/15

From a peak reading of 41/169.9 in March of 2014.

[PMRpro Ambassador in reply to nuigini]

Interesting how the ESR fell when the CRP went up so much - you'd expect them to track one another as they are linked by proteins. I think you need it repeated. I have a very suspicious mind - I worked in a lab and know what sort of things can happen

[nuigini in reply to PMRpro]

I'm going to be away for the next three weeks. I'll see what I can do about getting a retest when I return. I see what you mean.... the ESR/CRP readings have been tracking fairly consistently.

I'll be taking care of my grandkids and will keep an even keel. Fortunately, they are in school all day and old enough to understand and be very helpful with Grammy. We enjoy card games, board games, watching movies and going to the swimming pool.

[PMRpro Ambassador in reply to nuigini]

Sooner you nor me!!!!!!!

Make sure you have enough pred to go back up a bit if the stress gets to you! Have you got them all to yourself or will there be some respite?

[nuigini in reply to PMRpro]

DId you mean "Better you than me"?

All to myself. Have a sister-in-law two blocks away if I feel the need.

[PMRpro Ambassador in reply to nuigini]

Yes - I suppose that translates it

All I can say is "Good luck"!