PMR Pain vs Markers

[navejasjoe]

My wife has been tapering from prednisone very gradually. She was diagnosed with PMR 2 1/2 years ago, and was started on 15mg. Within 6 weeks her pain was almost non-existent and her ESR and CRP markers were at standard. She is now taking 11mg for every two days of 10mg. She has her bad days but overall she is able to function somewhat satisfactorily. But her numbers are at 39 for ESR and 16.6 for CRP. That was close to her numbers when she was diagnosed, yet her pain is no where close to what it was in the beginning.

If these numbers relate to the level of inflammation, why is it that the pain (thank God) is not nearly as severe as what those numbers showed at the beginning? We would like to hear what correlation there is in your situations between pain and their markers.

Thank you,

Joe

[Hindags]

Very interesting question. I have no definitive answer for you.

My only thought is that something other than the PMR is brewing, a UTI, or other infection that might cause the inflammatory markers to rise. Both ESR and CRP may rise from any number of reasons. Early on in my PMR journey my markers went up without other symptoms of PMR changing. My Rheumy did lots of tests to rule out other conditions. All were negative. She decided that it must have been a PMR flare and had me go up from 14mg to 20 for a week then rather quickly back down. Haven't had that happen again.

On the other hand last summer I developed an intestinal infection and my markers shot up very high while my PMR symptoms were the same.

[navejasjoe in reply to Hindags]

Thank you Hindags. My wife has been under some stress due to some cardiac issues that have arisen as a result of a chest scan that was done recently. She does have her appointment with her rheumy tomorrow to get her assessment.

Joe

[PMRpro Ambassador]

Not much at all for me - immobile with pain and ESR hovering at 16-18 maximum, although normally with NO pain it would be maybe 7.

But it doesn't SOUND as if there is no inflammation: "She has her bad days but overall she is able to function somewhat satisfactorily". That wouldn't be good enough for me. And how she was at 15mg is her guide: that is what she is aiming for at a lower dose and she should never feel worse at the end of a taper step than at the start. And it really doesn't sound as if that is the case.

ESR and CRP can rise due to other causes as Hindags says. That is why a single raised set of markers shouldn't result in a kneejerk raising of the pred dose. But if there is a rising trend - the chances are there is inflammation stacking up and eventually you will fall off the cliff edge.

[navejasjoe in reply to PMRpro]

My wife is having her blood checked monthly for her rheumy's direction, and as we are looking at her results, in the past 18 months, the numbers have rarely been at standard level. It is just that either the ESR or the CPR have been high, but never both in the same blood withdrawal. This time, they both shot up, which is what concerned us. We will check with her rheumy at tomorrow's appointment. Other medical issue have arisen of late that we will discuss with her for any correlation. Thank you.

Joe

[Hidden]

Hi Joe

Happy New Year to You & Your Good Lady 🥂

Sometimes the Markers can have no bearing on how you actually feel. Not everyone gets regular blood tests so they can’t compare feeling good/bad to blood levels.

I used to get my blood taken every month when l was on Methotrexate & invariably they pretty well matched how l was feeling.

Obviously the Pred is controlling her pain but she may have something else going on as Hindbags suggested.

Maybe your good lady might want to stick at 11mg for a while & then try to reduce again slowly.

I’m on 7.5mg & have been sitting there for two months & as yet don’t feel it’s quite the right time to aim for 7mg as l don’t want to upset the apple cart!

Hope you are keeping well.

MrsN

[navejasjoe in reply to Hidden]

Thank you, MrsN and happy 2019 to you as well. Glad you're sticking to 7.5mg. We're seeing the rheumy tomorrow so we'll find out how she sees it. Have a great weekend.

Joe

[DorsetLady PMRGCAuk volunteer]

As others have said raised markers don’t necessarily mean a flare in her condition. But if they continue to rise then should be investigated.

Is there anything else going on in her life (as if PMR wasn’t enough) to affect her?

I found when my husband was very ill and we were trying to get a diagnosis (terminal liver cancer) my indicators rose, but no symptoms of a flare of my GCA. Purely caused by stress.

[navejasjoe]

She is having other medical issues which may have her stressed out, thereby possibly elevating her markers. She is seeing her rheumy tomorrow. Thank you,

Joe