Good blood test results... but what does it mean?

[Ebn49]

After 4 months on Pred, started at 15mg, tapering 1mg at a time and currently on 10, I requested another blood test, and the markers are right down - ESR was 17, now 5, CRP (which the GP says 'isn't much of an indicator') down from 5 to 2. These sound pretty good, but does it mean the PMR is getting better? My understanding is that Pred doesn't treat PMR, it only masks the symptoms while the the underlying PMR burns itself out over time. So, do the low markers mean the inflammation is going, and that I should be able to keep slowly tapering the Pred without the PMR symptoms flaring up? Or is it just that the inflammation is under control now, but as I reduce the Pred it could just re-emerge? At 10mg I feel pretty good, although I do have some low-level sciatic-type feeling in the bum/hamstrings, so not entirely clear of symptoms. I was planning to follow a DSNS taper from here onwards. I'd appreciate your thoughts, folks...

[PMRpro Ambassador]

No - the low markers only mean that you are currently on enough pred to manage the inflammation shed each day (if they hadn't fallen there would be some cause for concern) and there is still the possibility that after a reduction step the dose would get too low and the inflammation can build up again. You only know PMR is gone when you get to zero pred and stay OK afterwards, and even then it can takes months for it to show up.

Your GP isn't entirely correct about the value of the CRP: everyone is different, some have a raised ESR that is meaningful, for some it is CRP, in some it is both, for some it is neither. If it was up at diagnosis and is falling now - it is meaningful for YOU. Which is what matters.

[SnazzyD]

It means that the Pred is enough to prevent the inflammation that would be produced by your condition or any other focus of inflammation that may or may not be related in your body. If you just stopped your Pred or dropped down too low, it would build up again and eventually you’d get symptoms back but not as fast as it would have done where your PMR was in full flow. The idea of slow tapering down is the hope that the disease activity is also reducing, the trouble is you don’t have a PMRometer on your head so it is guesswork, especially as markers increasing can be delayed. So, reducing slowly in small steps as you plan to do, means that if you outstrip the rate at which your condition is reducing you’ll have a much more accurate idea of which dose was ok and which was too low for now. Also, reducing with small steps means you should have a less intense withdrawal which can really confuse the issue as to whether it is PMR or just your body shouting about the lower dose on offer. Another thing under 10mg is the adrenal insufficiency that may present itself if your body hasn’t fired up its adrenal system yet once below about 8mg. This can make you feel ill and the guessing game starts again, so slow small steps can help.

[Arflane97G]

Spoke to my gp last week re. ‘Pleasing’ test results- inflammatory markers down from 133 / 80 ish to 8 and 1 with warning that this is ‘nothing to get too excited about’ - just means 10 mg of steroids doing their job!

[SheffieldJane]

It just means that Pred is working, keeping the dangerous inflammation under control and therefore the pain and stiffness. PMR lasts on average 5.9 years, hopefully most of that time the symptoms can be controlled by a low optimum dose. Symptoms rule!

[Ebn49]

Thanks everyone, that makes sense. I'll carry on with the dead slow taper plan I think