I have possible GCA undergoing usual high dose pred/ biopsy.
I had a letter from Rheumy ( copied me in as letter was to GP)
It said blood test revealed CRP 32 / ESR 40 and I am not sure what it means.
Interested to know is this a good result or showing inflammation?
Thank you
Results show high inflammation.
The results show there is inflammation somewhere in the body. But it is non-specific, although if you have GCA symptoms it is likely to be due to that.
The ESR is measured by setting up a blood sample in a vertical tube and seeing how long it takes for the top of the red cells to settle a measured distance. The speed is influenced by proteins on the surface of the cells making them stickier and the bigger clumps fall to the bottom more quickly.
CRP is c-reactive protein, one of the proteins I mentioned, and more of it makes the red cells stickier and they fall faster.
Whether the result is good or bad is relative - your results are both raised but not very high, some people have had results in triple figures, and the level doesn't always match the amount of inflammation. What matters now is that they fall with the pred you are taking.
Appreciate that explanation thank you in terms I can understand.
Simple question I think- how often should my Rheumy/ GP take blood tests?
Depends. Some doctors do it far more often than others and really I suppose it depends on whether you are reducing the dose of pred and the blood tests mean anything for you. My ESR and CRP are rarely out of normal range though we have discovered that they do rise at times but never go above about 16-18 for ESR. But relly it is a waste of time, symptoms are far more meaningful.
Most things are probably OK done every 6 months, maybe 3 monthly. But if they mean anything having ESR and CRP done between 2 reductions makes sense - is the current dose still enough, is it a good idea to try another reduction. Hba1c should be done every 6 months as long as it is stable in the normal range. If it starts to rise then it should be checked 3-monthly.
Thank you I found that really useful
You have some good info now but I can add the following.
My Rheumy allows me to manage my illness and tapering myself. He says if I have no symptoms carry on tapering. If I have symptoms get a blood test done. This establishes whether the disease is more active or if the symptoms are steroid withdrawal.
Any infection will raise the ESR so is not a reliable indicator for us.
CRP is made in the liver in response to a chemical called Interleukin 6. It is this IL6 which is overproduced in PMR and GCA. So if your CRP is raised that is generally and indication that the illness is flaring or not controlled by the steroid dose. A normal CRP would be low single figures and is considered to be undetectable at less than 5.
That isn't always entirely so: in some people ESR relates to their symptoms better than CRP. For example, my CRP have never been raised while the ESR has been raised from low single figures which is my normal to about 16-18 - but that was still "in normal range" so it only became apparent that it did match my symptoms in retrospect.
Yes I agree. The trouble is, when trying to give information to help others if we cover every single variant the piece becomes too complicated. I am always mindful of this if I decide to respond. Most of the population will fall in the middle of the distribution curve statistically I think, hence I tend to stick to the medically accepted norms initially. We can always draw on the unusual at a later date if necessary. Wouldn't life be so simple if we were all the same....
Exactly - unfortunately there are a lot of doctors who don't get that concept!
Cassie. Nothing in the discussion so far that I can add to from medical point of view. In my own case, I had a triple figure count when I eventually went to GP who pushed me straight off to hospital.:(afraid I was typical bloke about visits to dr). But since then, 2 years ago, I have 'felt better' (like normal) when CRP is less than 5 though apparently bell curve suggests normal is 7. I can feel when balance of pred vs gca is out of kilter long before bio indicators such as CRP/ESR say so. If it gets above 5 I know GP will 'agree' pred isn't working, and I have had two flares in last 12 months where CRP and ESR both into high 20s. First one was not taking recuperation slowly enough and relying on pred to prop me up, second was race to reduce pred level. All I can really add is that it is a very careful balancing act to get off the pred and we are all different. Sometimes specialists, GPS, papers on internet, all fail to understand how you feel. I hope your GP listens to you and your symptoms and helpstreatyou, not follow the book! Hope you find your own balance soon.
Hi Markwin
Thank you it so helps to hear the experience of others on this journey. It’s hard for me as my mother lived to be 98 with not so much as an aspirin and now I have to take all this pred. Don’t get me wrong I know it’s totally necessary but I struggle with the concept of taking meds for the foreseeable future I must accept it. It’s interesting that you say you relied on pred to boost you instead instead of recuperating. The power of rest is enormous and I must remember that.
Hope all goes well for you on this journey towards full health.
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