CRP/SED High-antibiotics

[Meg1711b]

I've been on pred 13 months. Reducing well last 3 months, and have gotten to 8, feeling good, only slight neck stiffness on occasion.

I was excited for labs today, because I felt certain they would show inflammation in the normal range.

Instead, showed inflammation still high (CRP 12.4 and SED 33). So discouraged.

Rhumy and I messaged a couple of times today-and I was able to get an appt tomorrow due to a cancellation . One option is to add an antibiotic- she is thinking minocycline. Anyone else been on this or other antibiotics to try to reduce the inflammation?

Any thoughts on whether you would want to increase pred in this situation?

My SED was 0 at time of diagnosis-only went up in Oct. My CRP started at 17, got an initial drop to 6, but tests since then 11, 26, 11 and now 12.4. (Had UTI when at 26.)

[PMRpro Ambassador]

Being to 8mg after 13 months is pretty good going. If you have few symptoms that suggests to me that there might be something else going on to raise the blood tests - particularly since you say your sed rate was low at diagnosis. It is very unusual for someone with a low sed rate in PMR to later develop it just because the dose is reducing and raising the dose shouldn't be done in response to raised bloods if the patient hasn't symptoms worth mentioning. Since you are on pred the UTI may have been going on for some time before it was treated and may still be there - pred can often mask UTI symptoms I found.

I think the rheumy should investigate other things - or send you to someone who might know if she doesn't.

[Celtic PMRGCAuk volunteer]

Meg, unless you are harbouring some sort of virus/infection, it is strange for your ESR to suddenly be showing an increase now considering it was 0 at diagnosis. But it is often considered that the CRP is the more reliable marker of the two and as this was raised at diagnosis, perhaps the ESR just lagged behind the symptoms. In fact, I'm wondering whether your rheumy is also considering a possible lurking infection, hence her suggestion of antibiotics. Certainly I haven't come across anyone being prescribed antibiotics alongside steroids to treat PMR. However, I have come across people who have been treated with antibiotics when succumbing to some sort of infection alongside PMR only to discover that their PMR pain improved! Pre-diagnosis when I was battling to find a cause for the pain that was keeping me tied to my bed, we were having our lawn treated and the gardener said he had just returned to work after 8 weeks off with severe pain which hit suddenly and in all the same areas of the body as me, unable to walk or lift his arms. His GP put him on a 6 week course of steroids and long-term dose of antibiotics and he recovered. That has always given me food for thought. You have been very lucky to get an appointment with your rheumy as soon as tomorrow - the increasing inflammatory markers alongside your occasional neck stiffness may be sufficient for her to recommend increasing the steroid dose slightly for a week or so to see if both your neck symptoms and markers improve, thus providing an answer. Don't be too discouraged if that is the case - flares in the inflammation can be quite common in the first 12-18 months of treatment. The important thing is to get on top of the flare with a small increase before it gets out of control leading to the need for the return to a much higher dose.

[Chihuahua1]

I agree with the others that there is probably something else going on. The most probable thing is some type of low grade infection, which would be a good reason for putting you on an antibiotic. Maybe your UTI is still hanging around in the background?