PMRGCAuk

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Feel good but CRP still elevated - rheum says increase pred

How much should CRP determine prednisone dose? I started at 15mg three months ago and had reduced to 7 by last week. When I started on prednisone, my CRP went down in a week from 44 to 8. It was down to 6.7 a month ago and now is 6.6.

I feel good but rheumatologist is concerned the CRP is still elevated and wants me to increase dose back to 10 for 2 weeks, then repeat the CRP. My triglycerides and cholesterol are up, despite exercise and healthy diet. It’s tough to balance the risks we face. I pushed back about increasing the dose. Waiting for rheumatologist’s reply.

What’s your experience with CRP? What would you do?

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Prednisone

12 Replies

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This makes a refreshing change. If I felt fine I wouldn’t increase. Symptoms rule. All manner of things can raise CRP even a slight cold. Your Rheumatologist is unusual.

I would give it another few weeks, checking the CRP and waiting to see if you have any symptoms. If there were a rising trend over that time or if any PMR symptoms reappeared, then I would increase. If it remains steady or falls further, you know you aren't about to flare. Some people have a naturally high CRP, lots of other things will raise a CRP level to some extent. I do see where he may be coming from but if you are OK at present, I would stick at 7mg. And it is early days - there might still be some bursitis inflammation that isn't cleared out - it took months for mine to all go - so if it were me I would be patient,

To reduce to 7 from 15 in only three months is excellent. If I were you I'd just stay at 7 mg for a while. This is often a sticking point in tapering anyway and also close to the dose where most side effects are negligible and the adrenals are starting to wake up. As long as your symptoms remain under control I'd suggest it would be counterproductive to increase pred as it may be harder to taper down again. If you were experiencing symptoms, however, that would be another story. Symptoms rule - whether for tapering or increasing or simply marking time.

Never thought I'd see the day we were disagreeing with a doctor about increasing a dose!

Your CRP is in the high normal range. I would be concerned and want to track down the reason as it could lead to future health problems. see healthline.com/health/c-rea... excerpt: "Expert opinion from the American Heart Association in 2013 states that when considering all risk factors, individuals with CRP levels greater than or equal to 2 milligrams per liter (mg/L) likely need more intense management and treatment for heart disease.

Elevated levels of CRP may have an important role in identifying those who might need closer follow-up or more intensive treatment after heart attacks or heart procedures.

CRP levels may also be useful in uncovering those at risk of heart disease where cholesterol levels alone may not be helpful.

The Centers for Disease Control and Prevention considers these conditions significant risk factors for developing heart disease:

diabetes

high blood pressure

high cholesterol

smoking

unhealthful diet

limited physical activity

alcohol use in excess

being overweight

A family history of heart disease also puts you at higher risk of heart disease.

I was under the impression that it is the hs-CRP that is significant in cardiac problems - measured differently and only applying to people whose CRP is in normal range and when it is raised because of inflammation it swamps the hs-CRP.

Thank you. I’ve been reading about the different CRP tests and will run this by a cardiologist. My CRP was normal the only pre-PMR time it was tested but they was probably 5 years ago.

Here is a link that explains that CRP and hs-CRP measure the same thing. My rheumy ordered the CRP test for me which has a low end of <2.9mg/L. I have found in the past a CRP reading below 2.9 can help identify other health problems so plan to ask for the hs version in the future.

thepathologycenter.org/uplo...

"CRP and hs-CRP Measure the Same Thing

Based upon orders and ordering patterns seen at the Pathology Center, there remains confusion regarding the chemical

nature and indications for CRP (C-reactive protein) and hs-CRP (high sensitivity C-reactive protein). This Technical Bulletin seeks to clarify the main points regarding these tests.

• Does the Pathology Center offer both hs-CRP and CRP tests? NO. hs-CRP is not a “special” or “heart

specific” CRP. CRP is CRP. Pathology Center personnel are not always aware of whether the intent of testing is for cardiovascular disease risk profiling, or inflammatory marker measurement. The hs-CRP test offered by the

Pathology Center serves well for either indication.

• How do hs-CRP and CRP tests differ? The hs-CRP assay design is technically optimized by the manufacturer

to measure CRP at low levels, within the reference (normal) range (around 1 to 3 mg/L). Originally, CRP tests were not designed to quantitate CRP at such low concentrations. There was only medical interest if the CRP was increased, not if it was high normal or low normal. Nobody cared about normal values. Cardiovascular disease risk profiling changed that.

• Why are the units of measure different? The CDC recommends hs-CRP be reported as mg/L, in order to

simplify provider and patient awareness of the cardiac risks associated with higher values as listed below:

• hs-CRP < 1.0 mg/L Low risk

• hs-CRP 1.0-3.0 mg/L Moderate risk

• hs-CRP >3.0 mg/L High risk

The “routine” CRP reference range is 0.0-0.7 mg/dL (mg/DECILITER). If a “routine” CRP has been used as an

inflammatory marker and a hs-CRP is performed, the results can in most cases be compared by simply dividing the hs-CRP value by 10 as this converts the value from mg/L to mg/dL.

• Is there any medical reason why CRP should be ordered instead of hs-CRP? NO.

• Is there any medical reason why hs-CRP should be ordered instead of CRP? SURE!

Cardiovascular

disease risk profiling.

• Are there special considerations for using hs-CRP for cardiovascular risk profiling? Yes, definitely! The test is intended to be useful only for patients found at moderate Framingham risk by ATP III criteria (1) (2) (3) (4) . It

is not for everyone, and the Framingham risk score should be calculated, from the patient’s lipid profile results,

first. If hs-CRP testing is then found to be indicated, two hs-CRP levels should be measured, fasting or nonfasting,

two weeks apart; then averaged. The average result is the hs-CRP value which is used to guide further

therapy. The patient should be metabolically stable and without obvious inflammatory or infectious conditions, which would elevate hs-CRP.

Thanks, it’s a worry. I’m going to run it by a cardiologist.

Thank you, everyone! So, the rheumatologist suggested a compromise: increasing to 8 and retesting in 2 weeks. I don’t really like even this increase but I’m beginning to get more concerned about the elevation. Anyone know how stress might affect the CRP? I can’t say I’m under tremendous stress so this probably isnt affecting my CRP, but I am concerned about my new grandson who was only at about the 3rd percentile when born. He’s 3 months old and growing, but slowly, on his own curve - still at or below 3rd percentile. I tend to obsess and research a little compulsively when it comes to kids’ and grandkids’ health.

I think stress can raise the CRP - DL will know more.

8mg is a low dose that is about the same as the amount of corticosteroid your body produces daily normally - called a physiological dose. It is accepted by all sensible doctors as a decent dose you don;t need to worry about.

Don't stress about the baby - both my daughters were well below the 3rd percentile at birth: one weighed 1300g, the other 1090g. The first was 8+ weeks prem, the other barely 5 weeks, either way they were small for dates (and the dates were definitely right, don't ask!). They are both still quite delicate little flowers size-wise but both healthy, one is a nurse (favourite job in NICU) and the other a paramedic. Both were fully breast fed and I spent the first year of their lives being nagged they were small - this was nearly 40 years ago so they weren't used to breast-fed prem babies who stayed small - but they too stuck to their growth pattern.

Thank you, PMRPRO. I appreciate the reassurance. Your daughters certainly were little girls. Glad to hear how well they are as adults. I can imagine the pressure you had back then. Our grandson was about 2500 grams, just barely above ‘small for gestational age.” Doctor seems not too worried and our kids like the doctor, He was only 2 weeks early - induced because he wasn’t continuing to grow well in utero. I don’t know if they ever labeled the issue as intrauterine growth restriction, but that seems like what it was. It’s been a stress on son and bonus daughter. We thought baby would begin to catch up by now but he’s just not a big eater. We hope he begins to catch up when he starts in solids, but he may just be a little guy. He’s a beautiful boy.

Mine came home at 2000g! It's like PMR - they are all different. My second daughter would have been able to come home if she had been that weight - she was perfectly healthy, just small. They need to stop comparing him with other people's babies - he is theirs and an individual.

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