Blood tests reveal high ESR whilst CRP in normal range

[Purplegirl70]

I was just wondering if anyone else has had blood test results which show ESR level as high (in my case 31mm when the normal range is 0-13mm) but the CRP is within the normal range (currently 8.7mg/l with normal range being 0-10mg)? Is this common? The reason I ask is I am starting to wonder the diagnosis of PMR was/is correct and I sense that my GP may be wondering the same thing

[PMRpro Ambassador]

ESR and CRP are not ever givens in PMR/GCA. They just add to a suspicion that there is inflammation somewhere. They can both be normal in up to 20% of patients, ESR is more often raised than CRP and very occasionally CRP may be raised but not the ESR. There are a very few doctors who insist if you haven't got a raised CRP it can't be GCA - it isn't true. It is medical biology - it has its own rules!

Why are you now doubting the PMR diagnosis?

[Purplegirl70 in reply to PMRpro]

Thanks for the quick response. When I saw the Dr last week she was insisting that I reduce my steroid dose (currently on 17.5mg and have been since November) I explained that I still have a very stiff neck and shoulders. Furthermore, I am still experiencing problems with walking, primarily due to a weakness in the thigh muscles which does not seem to tally with others descriptions of their PMR symptoms.

[Purplegirl70 in reply to Purplegirl70]

Sorry should have said after 'stiff neck and shoulders' that she said that that may not be related to the PMR but didn't offer up any other solutions.

[PMRpro Ambassador in reply to Purplegirl70]

Well, I imagine there are a lot of us who have PMR with stiff neck and shoulders!

Something called myofascial pain syndrome is more common in patients with PMR than in the general population though it is common enough there! It is caused by the same inflammatory substances as PMR except in PMR they are systemic, in MPS they are in the fascia (the transparent skin you will have seen in joints of meat and poultry) or concentrated in pairs of trigger points on either side of the spine in the shoulder muscles, about rib level and in the low back. They result in spasmed muscles - which irritate nearby nerves and cause referred pain and symptoms in the regions they supply. It responds to longer period of higher doses of pred but often returns at lower doses.

I have it and when it is bad I can't reduce the pred dose until it is sorted out. Bowen therapy helped a lot when I lived in the UK, here I get needling (google intramuscular stimulation) and therapeutic massage to mobilise the trigger spots. The trigger spots coincide with some of the fibromyalgia trigger spots and does sometimes confuse the issue.

Have a google...

[Purplegirl70 in reply to PMRpro]

Thanks PMRpro I'll have a Google

[JanetGarrettN in reply to Purplegirl70]

Purplegirl70 Good morning. I am in the states. I just wanted to comment on part of what you said. Referring to your walking and your legs/thighs. I was diagnosed in October 2017. While it is most common for the upper body PMR symptoms, I have the upper and lower body and what you describe is part of that. I became almost paralyzed in my level of pain and dysfunction. Absolutely amazed that 4 days of 15 mg Prednisone could have turned it around. Hope this helps. Janet

[Chrob in reply to Purplegirl70]

I had real problems with thigh muscles and walking was very difficult for quite some time even after prednisolone.

[Purplegirl70 in reply to Chrob]

Thanks Chrob. Although it is rubbish having this condition it is reassuring to hear that I am not the only one facing the same strugglrs.

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I had a blood test last week. CRP 4 ERS 40 UP FROM 37 a month ago.

[Purplegirl70]

Thanks JanetGarrettN. From around April 2017 I found it more and more difficult to walk. I mentioned this to my Dr in July who diagnosed it as muscle atrophy on the basis that I had been off work for a while with depression and, hence, was moving around less. Despite my best efforts to get build up my muscles my mobility got progressively worse and that was when she diagnosed proximal myopathy, though no information was given about how to treat this condition. After I had been back at work for 5 weeks and had reached the stage where I could barely walk 20 yards without having to stop and stairs were impossible to negotiate did she diagnose PMR. The pain I have in my shoulders and neck have been a constant for all my adult life but they initially subsided dramatically when I started taking Pred. Sadly they are as stiff and sore as ever now and I dread tapering the Pred as I fear they will get progressively worse and my mobility will be compromised. I work full time and although not on my feet all day I do have to be able to negotiate the stairs in buildings that are 4 storeys high on a regular basis and they are a real struggle.

[PMRpro Ambassador in reply to Purplegirl70]

Heavens - nothing like seeing zebras when it is a horse wandering round the garden is there!!!!

How long have you been on how much pred?

[Purplegirl70 in reply to PMRpro]

I started off on 15mg in September which was then increased to 17.5mg at the end of November. I have tried several times to reduce the dose but always seize up and my legs turn to lead. I had a message from the Dr yesterday telling me to reduce my dose to 16mg which i will try after the weekend as i am at a conference tomorrow and visiting family. Roll on Tuesday when I woll have my first day off since last Sunday.

[PMRpro Ambassador in reply to Purplegirl70]

I suspect you are simply having to do too much. You might also do better if you just reduce 0.5mg at a time, 1mg at the most. Or do it like this:

healthunlocked.com/pmrgcauk...

[Purplegirl70 in reply to PMRpro]

Thank you so much for directing me to this. It makes the prospect of reducing seem far less scary. I'll let you know how i get on

[PMRpro Ambassador in reply to Purplegirl70]

It has worked for a lot of people on the forums. Good luck

[Jura1959]

Hi Purplegirl70,

You are not alone with your struggles I to work full time has a high profile security officer for vip's.

I was diagnosed with one in January 2017 which started has a frozen shoulder I was put on 15mg of pred reducing down to zero in less than 12mth which I thought was very quick was ok for a month or so but all the pain issues started to return so doctor put me back on to 15mg of pred again, My Doctor now has concerns over GCA or (TA) Temporal Artherightous and as a result of this as increased my pred to 30mg.

My main issue is how very quickly my energy levels drain and my concentration levels drop I've always been very active doing sport Rugby Triathlon etc and I just loved doing all DIY Jobs around my home but find by the time I've been to work and get home I just collapse untill it's time to return to work again getting very little else done.

Yes I known we are all getting older and with age we slow down a little but I'm finding this very hard to except I'm 58.

[Purplegirl70]

I have exactly the same issues with energy levels and concentration. I've just had to get a taxi from the station to the hotel where I'm staying tonight as I've run out of energy and what little I have left I need for the 'networking' event tonight.