PMR Blood levels

[grunter546]

Hi I'm David from New Zealand. I have PMR and my doctor uses a blood count number to tell if my pmr is getting better or not. Last time it was 5 and he said I was clear. I'm waiting on more results to see if I have it back. I was reading your posts earlier and someone said pmr could effect your liver is this correct?

[HeronNS]

My doctor, fortunately, uses my symptoms to tell if my PMR is getting better. A quick google search confirms that pmr can and does affect the liver in many patients. Now I have something else to worry about. Although perhaps the corticosteroids help deal with the liver problems also?

ncbi.nlm.nih.gov/pubmed/100...

[piglette]

I assume that the blood count test is for your CRP which measures inflammation levels. 5 is pretty normal. It does not tell you that the PMR is getting better it tells you that the steroids have the inflammation under control. It is a good measure of how you are particularly at the beginning, although if it becomes raised and you feel OK it may be caused by a cold or something else other than PMR. Some people, around twenty per cent, never have a raised CRP level, so the blood test is not of much use. This sometimes seems to confuse doctors!

[HelenLeppard]

I have never had raised blood count, my GP goes on the way I am feeling, she told me that quite often the bloods do not tell if you have PMR or not, my Chiroprator was convinced in the beginning that I had PMR as well.

[PMRpro Ambassador]

If you are still on pred and the inflammation marker is in "normal" range all it means is that the inflammation is under control as you are taking enough pred to manage it - nothing more than that. It does not tell you that the cause of the PMR has burnt out - the only thing that does that is getting off pred altogether without a return of symptoms. Some people do not get raised ESR/CRP again while taking any pred even if they have a flare (return of symptoms). And some people may get off pred and then have a flare later - and the markers still don't rise. They are extremely unreliable much of the time and symptoms should always win over blood tests.

PMR can lead to raised levels of one or two liver enzymes, alkaline phosphatase is one. Though whether that means it "affects" the liver is unknown.

[Admiral06 in reply to PMRpro]

PMRpro, The Chicago Clinic states that only 5% of GCA occurrences take place in patients with normal levels of CRP. I would like to believe this includes PMR patients with low post-treatment CRP as well as first time diagnoses, as it doesn't differentiate.

[PMRpro Ambassador in reply to Admiral06]

If you work your way through all the medical literature you will find that the figures quoted range from 5% to 20% and even higher as you will see in Table 1 in this article:

ncbi.nlm.nih.gov/pmc/articl...

Since a lot of doctors would refuse to diagnose patients with a normal CRP as having either PMR or GCA I would be a bit sceptical about the lower end of the range. There are probably a lot of patients who have both GCA in the form of LVV that doesn't cause visual symptoms and PMR who are walking around with various labels - but not the right one.

The Chicago clinic doesn't have a monopoly on figures - that is just their opinion.

[Admiral06 in reply to PMRpro]

PMRpro, The Chigago Clinic number was for just CRP, not ESR and the numbers reported in Table 1 for this measurement are: 4%, 1.7%, and 1.2%; which are all significantly lower than the 5% reported by Chicago Clinic. My interest in this number is because my CRP fell 95% over 11 weeks to below 3 and I hope this means my risk of developing GCA has dropped accordingly. I found only one study that indicates this is true.

[Megams]

~That is interesting David - never heard that it affects the liver. Wonder if our other trusty knowledgeable folk know why this is so?

For what it is worth Dandelion coffee can be known to help detox & or support the liver.

As piglette mentions it will be your CRP level that you mention.

When I was first diagnosed with PMR (almost 2 years ago) my CRP level was 1. The ref. range (Labtests here in NZ) measure (<. 5). I have had a noticeable flare & my 5 is in bold print now. My ESR has climbed noticeably too - I am back to my original initial steroid dose of 30mg hydrocort .

A brief intense stressful 2 weeks in October highly likely cause.

[bunnymom in reply to Megams]

Sorry to see you had to raise your meds . That's always hard to do. Hope you are feeling better

[Megams in reply to bunnymom]

~Thank you bunnymom - starting to feel like a seasoned learner.

My biggest stumbling block is learning to disengage from advocacy for others who can't speak for themselves in a crisis situation

Blessings to you as always.

[PMRpro Ambassador in reply to Megams]

bmj.com/rapid-response/2011...

From what I can see, there doesn't seem to be much more connection than it being an expression of the presence of inflammation - similar to CPR. It is found in several rheumatic disorders, not just PMR.

[Megams in reply to PMRpro]

~Most interesting indeed even tho lot of medical speak, I get the gist - thank you PMRpro as always.

Your brain has been left intact with your very long PMR + journey.

What's your secret

[PMRpro Ambassador in reply to Megams]

It did go sort of AWOL for a while but I worked as a translator all the way through and have made it work very hard since that stopped with the forums (obvious or what?). But greasing the wheels very formly does seem to help

[DorsetLady PMRGCAuk volunteer]

Hi David,

Think it's probably more likely that the Pred can affect your liver than the PMR. It certainly CAN have an effect on most of your organs and hormones if you read the information leaflet, but obviously not everyone is susceptible to every side effect! The paper does make a comment to the effect that if you already have liver problems you should check before you take Pred - but that applies to lots of medication. Shouldn't be too concerned, we have enough to worry about already.

Whereabouts in NZ are you? My daughter lives on the South Island, fantastic country - looking forward to go back next year 👍

[PMRpro Ambassador in reply to DorsetLady]

Did you have a look at my link? Raised liver enzymes (not all, just some) happen in several rheumatic disorders - so not just due to pred, happens before it gets into the equation too.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

yep, perhaps I should have said "as likely to be Pred" rather than "more likely.." they both throw the body's functions into a cocked hat! So we lose either way.

[Megams in reply to DorsetLady]

~Dorsetlady - please let me know if you ever come through Auckland.

Hope your daughter has not been directly effected by the earthquakes - the Sth Island has really suffered.

[DorsetLady PMRGCAuk volunteer in reply to Megams]

Hi Megams,

Apt to fly direct to CHCH. My daughter lives near Methven, so no problem this time or previous big one.

She did wake up with the tremor, and heard the pictures in the living room shake on the wall, but hubby and the boys slept through it all!

Her eldest boy is at Victoria Uni, Wellington although he was at home at the time, but all his mates and flat in Wellington were okay.

Will be back over for next Christmas, and intend to stay for at least a couple of months so one never knows we might be able to meet up.

[grunter546 in reply to DorsetLady]

Hi Dorset Lady, I've had quite a few reply's and that has helped, When I first got PMR my test was 101 but this time (2nd time) it is down to 14 and is being watched without the need for pred yet. No liver problems either. I am in the North Island in Manawatu, about an hour north of Palmerston North. I hope your daughter wasn't too near the earthquake centre.

[DorsetLady PMRGCAuk volunteer in reply to grunter546]

Glad to hear that. Daughter fine thanks - see above reply to Megams.

Take care.

[Megams]

~Christmas 2016 or Christmas 2017?

Glad to know your family not too effected by the latest string of quakes - never known little "ole NZ" to be so badly battered by Mother nature. We don't know we are alive in Auckland although our dormant volcanoes (of which there are a handful) just might yawn & wake up one day - bit like PMR

Be lovely to met up one day if passing through

[PMRpro Ambassador in reply to Megams]

Most UK English users would say this xmas for 2016 and next xmas for 2017...

[DorsetLady PMRGCAuk volunteer in reply to Megams]

Mean Christmas 2017. Intend to come end of Nov and stay until early/mid Feb. Haven't run that past the family yet - so we shall see! Don't know if S-I-L would cope, even thou he's very laid back and it's his busy time on the farm anyway!

Take care.

[Megams in reply to DorsetLady]

~I see... tricky balancing act u think and keeping family happy at the time it sounds.

Hope u do decide to visit.

[DorsetLady PMRGCAuk volunteer in reply to Megams]

Actually, It was a bit tongue in cheek - I know I will be welcome!