Random question about ESR level and taper

[Achybreakyheart]

Is ESR 33 an okay level? It's been creeping up as I taper. At 9.5. I feel not bad.

[DorsetLady PMRGCAuk volunteer]

No, not really - it should be about 20 or maybe below if you are on Pred.

However it can be raised by many things other than PMR. Have you had a virus or some other illness? An operation or just stress can make it rise as well.

If you can’t think of anything that might have affected it, I suggest you get it checked again in a few weeks - just to make sure it’s not getting any higher. Of course it could just be a blip - but best to monitor it.

[Achybreakyheart in reply to DorsetLady]

Thanks! Good advice! It was 25 when on 15. Hasn't been below 30 (top of normal range) since tapering. Will get it checked again.

[piglette]

On my blood test results it says the normal range is 3-35, I think it goes up as you get older. I think the important thing is what yours is usually, if it is normally say 10 and then goes up to 33 that may be a problem, while if it is normally around the 33 mark it may be not so much of a problem. I don’t think my ESR has ever been below 32. They say inflammation markers are second however to how you feel though.

[DorsetLady PMRGCAuk volunteer in reply to piglette]

Hi,

Nine years ago, pre GCA mine was 30 and deemed to be okay - which was why we went down the wrong route!

A couple of months ago, it was 28 (now being investigated because “in remission”) and it was stated abnormal. Same hospital path lab doing the tests.

However figures from patient info - so who knows!

ESR: the normal range is 0-22 mm/hour for men and 0-29 mm/hour for women.

CRP: most people without any underlying health problem have a CRP level less than 3 mg/L and nearly always less than 10 mg/L.

No wonder we get differing reactions from GPs at times.

[piglette in reply to DorsetLady]

Just had a call from the on duty GP to say mine has gone up to 77 from 74! I asked about the ESR but they seem to have cocked up that test.

[DorsetLady PMRGCAuk volunteer in reply to piglette]

Had my ESR tested last Wednesday - phone call Thursday- sorry didn’t get delivered to hospital!!?

Was beginning to feel paranoid - but apparently none of the blood did that day! No one was willing to explain why

Re tested yesterday!

Not urgent in my case, but for others it may have been - not good!

[piglette in reply to DorsetLady]

I am always suspicious how my blood tests disappear although they have not said they never received it, perhaps because the hospital van picks them up, so it is not a good excuse. This time they said not enough blood, they had two phials full! Perhaps they dropped it. I have bruises on both arms from last week when the nurse failed to get any blood out of me again until the fourth time, so none too keen on giving any more.

[PMRpro Ambassador]

No, by any standards it is raised. Up to 20 is the max but YOUR personal level may be lower. The range applies to a large population of people (10,000+) and not to each individual.

But more concerning is the fact you say it is creeping up as you taper: that means you have overshot what you are aiming for which is identifying the lowest dose that works as well as the starting dose. You shouldn't feel worse at the end of a taper step than at the start and if your markers work to monitor the situation they should remain stable at the lowest level they got to.

How long did you stay at 15mg? Was the ESR lowered and stable at that? i.e. not still on its way down.

The range for ESR used to be adjusted for age but that was discredited some years ago when it was accepted that being higher suggested there was actually unrecognised inflammation present, it isn't a normal part of aging which had been the claim. Whatever - it is YOUR personal figure that is important and the guide is the level you can achieve at the start with the original dose. That applies to both symptoms and ESR/CRP. If they are raised again that isn't immediately a sign to go back up the dose, they should be repeated in the next week or so to see if there is a rising trend. If there is, then the dose is probably now too low. But since both ESR and CRP are very non-specific, lots of other things can lead to a rise.

[HeronNS]

You should always go by your symptoms. I wish I could remember where I read that increase in inflammation markers by itself is not a reason to increase pred. If your symptoms have worsened, then you increase the medication. I think otherwise people might be taking more pred than necessary. Inflammation markers can for up for a number of reasons, not just PMR activity.

[PMRpro Ambassador in reply to HeronNS]

I say it all the time - but it is in a paper somewhere!

[HeronNS in reply to PMRpro]

I feel I just read it a day or two ago. Was it in that post featuring Dasgupta?

[PMRpro Ambassador in reply to HeronNS]

I've said it in the last couple of days

[HeronNS in reply to PMRpro]

I believe you....

[Achybreakyheart]

Thanks all!