Conflicting ESR and CRP results, GCA

[tomh]

Have had GCA for 9 years. 4 relapses, first at 1mg Pred, others between 7-10, although I believe one or all of them, may have been false ESR/CRP results due to other inflammatory conditions, and not GCA. But in any event, in all cases, both ESR/CRP readings were well above 'normal'. I reduced from 7.5mg to 6.8mg 2 weeks ago, having been about 3 months on former dose. Since the 'false' readings, I have tended to 'self diagnose', believing that if the GCA were to become active again, I would have pre-diagnosis symptoms of continuous dull headache, and itchy scalp. I have had a headache, but, during the pandemic, this has not been unusual for me. No itchy scalp, or other symptoms. I have lived in Brasil for past 6 years, and previously attended Bristol Eye Infirmary when in UK. Now to the matter at hand. I had marker test last week, and my CRP was 0.25mg/dL ( 2.5mg/L which I believe is what is quoted in UK), and ESR was 51mm for 1 hr. The CRP is good. However, the ESR not so. My Consultant in UK said that ESR should normally be below half ones age. I'm 74, so 51 is not good. I have no bone loss, and have my 'renals' checked regularly. I examine my temporal arteries daily for any signs of enlargement. I am reluctant to increase pred, again.

Any thought out there would be much appreciated.

Apols. for length of post.

[PMRpro Ambassador]

No single raised ESR or CRP without a return of symptoms should result in a kneejerk increase in steroid dose on the assumption it is the PMR. The bloods should be checked a week or two later to establish if there is a rising trend which would be the case in a flare. They are so non-specific they are only part of an overall picture. ESR can be raised by a cold, and injury - a whole range of things. However - it isn't entirely safe to assume that symptoms of a flare will be the same as the initial ones, they aren't always.

Your consultant is a bit out of date - the normal range for ESR is up to 20 for men. No adding bits to account for age - it was originally considered that ESR rose naturally with age, that is no longer so, the higher results for older people in the original studies were most likely at least partly due to undiagnosed conditions and any inflammation, even low-grade, is a risk factor. Even when almost unable to move with a major flare my ESR trundled along at 16-18 - in normal range maybe but extremely raised for me as my normal is in low single figures. And if your ESR was running at 35 - which it seems he would accept - it is raised for some reason.

[Amkoffee in reply to PMRpro]

For about two or three years before I was diagnosed with PMR I had a consistently High ESR. My GP told me it could just be related to my lower back which has chronic pain due to several conditions. It wasn't until I started having the pains in my upper thighs that I went back and he tested my CRP which was also elevated. Then he diagnosed it as PMR.

[DorsetLady PMRGCAuk volunteer]

During my GCA my ESR was raised for no apparent reason - no symptoms, nothing untoward.

I realised in retrospect it was caused by stress alone - my late hubby was very ill with terminal illness and consequently died.

A couple of years ago, no GCA, no Pred my ESR was high again - and GPs went into a bit of a panic- investigation showed this time caused by 2 joint replacements within 8 months (knee replacement notorious for raising ESR apparently).

Post re -

healthunlocked.com/pmrgcauk...

So just monitor for symptoms - and have you been under any specific stress lately or done anything that could account for readings?

[tomh in reply to DorsetLady]

Thanx DL for your input.

Only the usual 'stress' associated with the pandemic. I did have a Total Hip Replacement in Feb. this year .but , touch wood, op. went fine and almost as good as new now. No further problems with hip.

[DorsetLady PMRGCAuk volunteer in reply to tomh]

Good, my hip done last year - brilliant!