CRP

[Constance13]

In May my CRP level was 2+, now it’s 35 - could this be the top of the “normal” level for a 79 year old?

[podo]

Sounds high to me. I'm also 79 and my crp is generally less than 5. Worth bearing in mind that crp measures inflammation in general not just PMR related and could be due to an infection for instance. How crp varies over time gives a better indication.

[PMRpro Ambassador]

Are you sure you mean CRP Constance? 35 is the top of the range for ESR, CRP is a much lower figure, usually under 5. But the fact it has risen shows there is an increase in inflammation somewhere - either your PMR or possibly a chest infection?

The normal range isn't that a single PERSON can have the entire range a various times, it is the range of results that were found in a large population of healthy patients (10s of thousands usually). A single person will have a level thatis normal for them - and if it is higher, there could be something going on.

[Constance13 in reply to PMRpro]

Definitely CRP - got the result in front of me (from nephrologist - she hadn’t checked the ESR). No kidney trouble, no chest infection, no soar throat. Damn and double damn - must be the PMR (down to 3.5/4).

[PMRpro Ambassador in reply to Constance13]

Sorry! I've said I think you should stick with 5mg!!!!!!!!!

[Constance13 in reply to PMRpro]

Silly me - I have no choice now, have I?

[DorsetLady PMRGCAuk volunteer]

Hi Constance,

This doesn’t sound right for CRP as PMRpro has indicated, and as she also says figures are more specific to individuals but here’s some figures I did find so may give an indication -

ESR & CRP Range

ESR

Sed rate, or erythrocyte sedimentation rate (ESR), is a blood test that can reveal inflammatory activity in your body. A sed rate test isn't a stand-alone diagnostic tool, but it can help your doctor diagnose or monitor the progress of an inflammatory disease.

When your blood is placed in a tall, thin tube, red blood cells (erythrocytes) gradually settle to the bottom. Inflammation can cause the cells to clump. Because these clumps are denser than individual cells, they settle to the bottom more quickly.

The sed rate test measures the distance red blood cells fall in a test tube in one hour. The farther the red blood cells have descended, the greater the inflammatory response of your immune system.

Averages (based on 1996 study)

Age 20. Men 12, Women 18

Age 50. Men 14, Women 21

Age 90. Men 19, Women 23

Another study shows slightly difference values -

Age under 50. Men 0-15, Women 0-20

Age over 50. Men 0-20, Women 0-30

CRP

Clinical Indications

C-Reactive Protein (CRP) is the most sensitive acute phase protein and is the assay of choice in most situations when detection or monitoring of the acute phase response is required. CRP is specific for the acute phase response and unlike ESR is not elevated due to other causes. It has a rapid response time and will rise within two hours of acute insult (surgery, infection, etc.). CRP has a short half life (8 hours) and should peak and begin decreasing within 48 hours if no other inflammatory event occurs. It's catabolism is not affected by the type of inflammation.

CRP Reference Range

Adult: less than 8 mg/L

Up to 1 month: less than 6 mg/L

Most patients (90%) without organic disease have CRP levels less than 3mg/L and 99% have levels less than 10mg/L. Neonates are unable to induce CRP synthesis to the same extent and the neonatal reference range is lower.

Slightly higher CRP levels may be found in pregnancy, but any increase is usually within the reference range quoted.

The problem is, as individuals, we don't usually know what our normal is as it's not a test that is done when you don't have anything wrong. Some people's are a lot lower normally than the averages stated.

[Constance13 in reply to DorsetLady]

CRP was 2+ in May, 35 now. I had extremely high blood results at the beginning of PMR - 6 years ago (ESR 134, CRP 100+)😡 they have been up and down like a yo yo ever since.

[PMRpro Ambassador in reply to Constance13]

Because your doctors keep trying to get you off pred. Stick at 5mg - it kept you pretty good for ages didn't it?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Totally agree!

[Constance13 in reply to PMRpro]

Not my doctor, he’s marvellous and keeps telling me “listen to your body”. Rheumy not impressed.😡

But I must admit it’s ME not them. Keep thinkng I’ve got to TRY and get off the stuff.😏

[PMRpro Ambassador in reply to Constance13]

Why? If you need it, you need it! Your body is shouting at you!!! It can't do much more

[fionajohnson37 in reply to DorsetLady]

Thank you for this explanation of the two different blood tests - I have GCA diagnosed in January 2018 and am reducing my pred down now to 13.5 having started at 60mg.....I have CRP and ESR measured fortnightly and currently my ESR is stable at around 13 but my CRP is rising.....when I saw my rheumatologist last he said that he favoured ESR over CRP so I have carried on reducing my pred despite some increase in symptoms (these could be withdrawal effects rather than underlying) Do you know which is the more effective measure? Given I had the second increase in the CRP despite the ESR being stable I did not reduce my pred after the last blood test and today am beginning to feel a little better. Part of the problem is that I have just returned from a two week holiday where I did push my boundaries and also had a lot of tooth-ache/jaw-ache for which I took co-codamol and I am not sure if this was GCA related or a secondary infection....it appears to be resolved and I am no longer on co-codamol. What do you think?

[PMRpro Ambassador in reply to fionajohnson37]

"when I saw my rheumatologist last he said that he favoured ESR over CRP "

How strange - the ESR is so non-specific it is often of little use as so many things can affect it and the mainstream opinion is that CRP is probably more reliable. Individual patients may vary though and for some ESR may provide a good monitoring tool while CRP doesn't. CRP is fairly specific to inflammation although chest infections will send it up. And then there are people like me where they are rarely out of normal range - so tend to get ignored even when they are raised for me.After 14 years though - I have recently had evidence of both being raised!!!!

However - you say you have returning symptoms and symptoms trump blood tests, ALWAYS.

[DorsetLady PMRGCAuk volunteer in reply to fionajohnson37]

Totally agree with PMRpro - although not all surgeries do both. My second one only ever tested ESR.

But as we say again and again - symptoms are always the key! Reduce according to them, or rather lack of them!

[Marymon]

When I joined this caravan in April, I was told my CPR was 29 (age78), mentioned this to my present Dr., who said he didn't put much store by it.

I was thinking of asking him if I could have another one, as I will be seeing him on Friday, the last few days have been rough, reduced to using a stick again. Pain in left shoulder, upper arm, hip, thigh and sharp pain in shin bone down to my ankle.

Had reduced from 11.5 to 10 over previous week, allowing my confused Immune buddy getting the upper hand again. Took 12 early hours, a little better today.

Will definitely try to get Dr. to explain about high CRP, as we both seem to be way off the scale. Otherwise what is causing the high reading.

[PMRpro Ambassador in reply to Marymon]

"who said he didn't put much store by it"

I'd certainly want to know WHY - the rest of the world of PMR seems to make use of it. But you have symptoms anyway - and they are king...

[Marymon in reply to PMRpro]

I agree, didn't push him on it at the time, as it was my first app. with him after first Dr. and I didn't hit it off when I started to query him!!! so was trying to start off on a better footing. But, after this last week I want to know more.