Making sense of all the data CRP/ESR

[Sonofjimmy]

Evening All,

We have another planned meeting with my dads Rhummy to morrow as a planned follow up from his recent two weeks in hospital for admission of suspected infection (fever unknown origin was the discharge brief). The infectious diseases consultant along with others again expressed genuine confusion over his diagnosis and how he presented himself while in hospital (Extreme fatigue, heavy sweats, black dots on fingers, swollen feet, painful calf's). A number of doctors commented on potential vasculitis however they would all state they could not formally diagnose without discussing with his Rhummy who has previously diagnosed R/A - PMR. His brief visit prior to discharge again blamed the R/A disease and the fact that he has been on high dose steroids since June and no vasculitis!

We again raised the point that he has had no R/A PMR pain since July and has recently dropped from 40-30-20-15 within 10 weeks without pain. He then pointed out the his CRP & ESR levels are raised and this would suggest the disease is still active?

A review of his CRP data showed the below and identifies high CRP levels with no pain and recently on lower pred levels than earlier in the year when extreme pain was present?

without having any ESR levels for the second half of the year, the data showed a non consistent level between CRP / ESR with the ESR more settled. Would this provide any indication to a potential vasculitis condition or other

We have developed some graphs and spread sheets looking into all the data we have from my dads records and have started to look deep into all his previous specialist appointments to see if there is anything to go off. This continuously provides mixed diagnosis between appointments with the consistent comment that he does respond as a common R/A patient

Thanks again appreciated

MonthCRP Pred

Dec-16 56

Jan10 0

Feb10 0

Mar9 15

Apr20 15

May28 12.5

Jun110 50

Worse pain ever!! 10/10

Jul1550: R/A PMR Pain left & not since returned

Aug3340

Sep4330

Oct8030

Nov17020

Dec9015

[PMRpro Ambassador]

I'm sorry - I can't remember, where are you?

[Sonofjimmy in reply to PMRpro]

Liverpool PMR pro

[Hidden in reply to Sonofjimmy]

Liverpool have a multi disciplinary Vasculitis clinic led by Dr Janice Harper who is a Nephrologist.

rlbuht.nhs.uk/departments/m...

[Sonofjimmy in reply to Hidden]

I will look into this thanks Keyes,

[PMRpro Ambassador in reply to Hidden]

Thanks Keyes!

[Hidden]

Hi,

Vasculitis ( there are over 18 different types ) is very much a clinical diagnosis made when considering a number of factors including symptoms, bloods, imaging etc.

As it's a rare, complex condition then the only way to have it ruled in or out definitively is to see a Rheumatologist ( or Nephrologist ) who has an interest in it and manages a lot of Vasculitis patients. As your Father is on prednisolone it makes the diagnosis much harder as it masks symptoms.

The data will only make sense to a clinician who has the knowledge and experience to interpret it, I can't stress this point enough. I speak as someone who is part of the Vasculitis UK charity helpline team and has some knowledge in this area.

I would respectfully suggest you need a specialist second opinion and it's worth doing some research beforehand to identify a Consultant.