Neutrophils and monitoring inflammation etc

[Rimmy]

Hi all

I am no 'chemist' ('help' PMRpro ?) but thought it rather interesting that both times I have experienced as 'flare' or more accurately a response to me 'overshooting' my taper past the point where Pred could effectively control inflammation for my PMR/GCA - that my blood tests at those points showed 'relative neutrophilia'

Some background info:

'Neutrophils are a type of white blood cell that helps heal damaged tissues and resolve infections. Neutrophil blood levels increase naturally in response to infections, injuries, and other types of stress. They may decrease in response to severe or chronic infections, drug treatments, and genetic conditions.

Neutrophils help prevent infections by blocking, disabling, digesting, or warding off invading particles and microorganisms. They also communicate with other cells to help them repair cells and mount a proper immune response.

The body produces neutrophils in the bone marrow, and they account for 55–70 percent of all white blood cells in the bloodstream. A normal overall white blood cell level in the bloodstream for an adult is somewhere between 4,500 and 11,000 per millimeters cubed (mm3).

When there is an infection or another source of inflammation in the body, special chemicals alert mature neutrophils, which then leave the bone marrow and travel through the bloodstream to the site in need.

High levels

... [are] known as 'neutrophilia'.

Rises in neutrophil levels usually occur naturally due to infections or injuries. However, neutrophil blood levels may also increase in response to:

some medications, such as corticosteroids, beta-2-agonists, and epinephrine

some cancers

, physical or emotional stress, surgery or accidents , smoking tobacco

pregnancy, obesity, genetic conditions, such as Down syndrome, surgical removal of the spleen.

Some inflammatory conditions can increase neutrophil levels, including rheumatoid arthritis, inflammatory bowel disease, hepatitis, and vasculitis'

( medicalnewstoday.com/articl... )

So this info is surely quite interesting (?) especially inrelation to this info below I think which discusses keeping an eye on these during or following tapering of Pred:

'Neutrophil CD62L may represent a good surface marker for monitoring disease progression following glucocorticoid tapering. SAA and IL-6 exhibit a sharp decrease at early time points, increasing at day 90. In the future, a larger, longer study of neutrophils and their CD62L expression could support clinicians in their decision when and how to re-evaluate therapy in GCA patients'

( ard.bmj.com/content/76/Supp... )

Any comments would be of interest - have others noticed this in their blood tests ?

Best wishes

Rimmy

PS. This is (apparently) a 'baby Hamster with a cast on its tiny 'arm' ....

[Hidden]

Hi rimmy..sooooo cute.

Re neutrophils..what does relative neutrophils mean? Mine are always increased as is white blood cell count. Do you have blood tests as a matter of course or just when flaring...you may have said but I got distracted by the picture. I always expect mine to be out of normal range because of pred etc. I have 3 monthly tests due to dmard - which will effect neutrophils as well I think.

[Rimmy in reply to Hidden]

'Relative neutrophilia'or 'neutrophilia refers to an increase ' to a higher than normal number of neutrophils. ... during an infection or acute inflammation when the neutrophil count remains elevated' . I have periodic blood tests mainly to keep an eye on my ESR and CRP levels amainly and do the HBA1C test to make sure I am not developing pre-diabetes signs or diabetes itself. Luckily not - but I noticed that my Neutrophils were on the border of being 'high' during two flares as mentioned and that is what interested me !

[Hidden in reply to Rimmy]

I will have to dig my last few test results out. In the past year my crp has reduced from 6.1 to 1.6....previous 12ths 52 to 6.1 and my pred from 14mgish to 6mg over the 2 years . I have just seen neutrophils as outside ref range and not taken notice of figures. If I can find them I will be able to compare. That's a big if!

[SheffieldJane]

How interesting. A bit above my head, though, and it feels important and relevant.

What a sweet baby hamster. Totally get him. ❤️

[Blearyeyed]

I am going to read your links with interest but I just wanted to say , oooh! Ahhh! Poor little mite ! about the photo ( he looks like I feel !!)

Keep him safe in a cuddly mouse bed and hope he recovers soon😘😘

And you yourself , of course 😍

[Rimmy]

He's not actually 'mine' I saw him on the Net and thought what a poor wee 'darling' - but obviously well-cared for as should all of us be !!

[Robinsnest72]

What an interesting article. Yes, I have questioned the neutrophils with my Reumy. I was diagnosed in August 2018 with PMR I get blood work done monthly and get the lab results off the computer the next day. In Dec when my pred was at 15mg my neutrophils were hi at11.8 White blood count 11.6 and red blood count 5.43. When I questioned the rhemy he said no worries it is from the prednisone. I am now on 7mg pred and my neutrophils are now 6.9 which is in the normal range. My CRP is down to 3.2 from 53 and ESR at 7 from 25. I experience stiffness every morning and slight pain in upper arms but choose to live with this as I hate the pred. I am one who does follow the blood work. I would sooner live with a bit of pain than take pred when I look at what it has done to me. My clavulin has been swollen and my muscles effected. I go to exercise twice weekly trying to regain or hold onto muscle strength. Did not get Moon face but have gained 15 pounds

[Rimmy in reply to Robinsnest72]

Thanks - you seem to have found the path which suits you best - we all need to do that our own way. I am puzzled by the term 'clavulin' - isn't that a drug ?

[Robinsnest72 in reply to Rimmy]

Again, you are absolutely right. I suffer from brain fog. Being a pharmacy tech for 19 years I certainly know what clavulin is. I should have said clavicle. It is the indentation between your collar bone and apparently there are glands there. It was never swollen till I started pred. Doctor says it is fat accumulation. Thanks for correcting me. It is so hot here today hard to think.

[Rimmy in reply to Robinsnest72]

Thanks - we all get the 'fog' sometimes !!

[PMRpro Ambassador]

Hope you don't mind Rimmy - I've edited your post to turn the two links into direct links from your post. You must have spaces before and after the link or it doesn't turn into one automatically.

Dasgupta and a group at Imperial (I think) did a study a few years ago where they found that there is evidence of still active inflammation even after 6 months of high dose pred: in the form of neutrophils in the tissue. They also postulated that these neutrophils might be useful in monitoring the course of disease.

However - steroids increase the neutrophil count anyway. The Dasgupta and co study seems to suggest that that may be how steroids work (since no-one really understands the mechanism). So I don't get how they think they can be used for monitoring easily. I don't fancy blood being taken every month!!

[Rimmy]

HI PMRpro - thanks for the editing to the links. Interesting info and I was wondering that - about the impact of the steroids on neutrophils and how to concurrently consider the relationship to inflammation - but since neutrophils increase in other anti-inflammatory diseases not necessarily being treated with Pred I was thinking that they may be a useful to look at anyway. I only have bloods done about 3 monthly - that's enough for me - or has been. I was most relieved to see tapering from 16-12mg over the last 3 months my HBA1C which was sitting near the pre-diabetes mark last time is well back to a (low) 'normal' range - so that cheered me up anyway - and I ate cake (ha ha !!)

[PMRCanada]

I looked back at my bloodwork results for the month I was under a rheumy’s supervision, and all my neutrophils levels were in the normal range (between 2-7.5).....5, 5.2, and 4.9. One of those months I did have a high CRP (6.9, when upper limit is listed as 6). So not sure I see any connection, but I wasn’t getting my lab results the previous 3 months when I first started seeing her.

Of note my RDW (the amount of red blood cells and variation that may indicate a nutrient deficiency, anemia, or other underlying condition), was high on multiple tests.

[HeronNS in reply to PMRCanada]

I don't know anything about neutrophils. Is that a special test or is it in the complete blood count or whatever that's called?

[Rimmy in reply to HeronNS]

Here in OZ this comes up as part of a full blood count (FBC)

[Rimmy in reply to PMRCanada]

Interesting in OZ - on our results I had a CRP level of 5 once which was 'bolded' as of note - so clearly there are differences where they draw lines in different countries .... probably all about $$$ in the end even if for us this has implications !

[Purplecrow]

You'all talking such fancy smart talk...and I thought Neutrophil is the name of that little critter you're holding in the photo.

Carry on💃🏼, ...Jerri

[Hidden in reply to Purplecrow]

😂😂😂

[Rimmy in reply to Purplecrow]

Not me actually holding the Hamster - I just admired it from afar - but yes what a good name that would be ....

[Purplecrow]

Got it🤣

[Snowy12]

My neutrophil was11.7 prior to GCA now 7.6 down to 22.5mg pred