High CRP?

[Darcy2000]

I have both PMR and GCA I am on a tapering Pred schedule very slowly and currently I am at 17.5 having started at 50 about a year ago. Feel generally well with little or no symptoms from either disease . You would almost think I was Near remission . However CRP is still high at 33 meaning there is still inflammation. Dr want to start me on Actemra but when you feel well even with high CRP a bit nervous to rock the boat. Any thoughts?

[DorsetLady PMRGCAuk volunteer]

You’re not near remission - but lack of symptoms shows illnesses are being controlled by Pred quite nicely thank you.

As you’ve reduced from 50 to 17.5mg without issues and within a year, personally don’t see the need to add in Actemra at the moment. But as it might be useful in future if things get more difficult, so maybe suggest that to Rheumy.

As for raised markers (2nd post) - not always PMR nor GCA - as I know. Have you been under extra stress lately or done anything that might account for them?

As an aside, you can edit your post if you need to - saves raising a new one.

[Darcy2000 in reply to DorsetLady]

Thanks and yes tons of stress but good stress ..moving house after 40 years and babysitting 3 year old twins

[DorsetLady PMRGCAuk volunteer in reply to Darcy2000]

Well, that’s probably why then - luckily you didn’t flare, so take that as a good sign.....also as a sign that maybe Actemra not required at the moment.

[PMRpro Ambassador]

There are a few people on the forum with consistently high CRP levels despite not having symptoms. And as DL says - stress can raise it too. One common rule in PMR/GCA is that raised markers without symptoms should not result in raising the medication level. I'd count adding Actemra as raising the medication level!

[SnazzyD]

If it was me, I’d not be wanting to add another powerful immunosuppressant unless there was clear evidence of GCA flare in the shape of specific symptoms or symptoms of other vessel involvement. This is because inflammatory markers are not specific to GCA. If it was due to some other focus of infection I wouldn’t want to suppress and hide it with more meds for no good reason. You’ve had some monster stress, so do be careful and I’d be wary of rushing to a reduction until you’ve had a rest. 18mg was when I nearly had a flare (as I sat in a Taxi leaving Rome everything started to come back over an hour) but pulled back from the brink, so don’t be fooled. Luckily as it covered a holiday, I had already decided to stick at 18mg for 5 weeks and this really helped as it was also a real break from the body stress of reductions. Yes, I got told off by the Rheumatologist who started talking about Actemra because I should have been lower, but I noted that I hadn’t actually had a flare so why fix it if it ain’t broke? That was August 2017 and I’m now on 0.5/0.25mg with no hitches so far.

[Darcy2000 in reply to SnazzyD]

Thanks very much ...another immuno suppressant is NOT what I want right now will. CHat with Dr and see what he says