Can you have Polymyalgia with normal CRP and ESR?

[Jane424]

My GP says my bilateral shoulder and hip pain cannot be polymyalgia because my blood tests are normal. My pain started in the last 6 weeks. Worse in the morning. I am 80, northern European and Swedish descent. I also have other autoimmune diseases: celiac, PCOS and they run in my family: Crohn's, spondylitis, autism. I have stable Multiple Myeloma with low IgM, clear bone marrow and last year's MRI showed no lesions in any bones. My chiropractor who has polymyalgia patients says that's what he thinks I have.

Any help would be so appreciated. Thanks.

[PMRpro Ambassador]

I've already listed these 3 links on your original question:

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

researchgate.net/publicatio...

[PMRpro Ambassador in reply to PMRpro]

And a PS - they can be within the lab's normal range but still be raised for you personally. Normal range is the range of readings found in 95% of a healthy population - there can be outliers in the 2.5% at each end and if your personal normal ESR is low single figures, readings in the upper teens are well raised for you.

[Hidden in reply to PMRpro]

Mine were in upper teens when they eventually decided it was PMR.

[DorsetLady PMRGCAuk volunteer]

Your doctors need to get up to date - up to 20% of PMR patients never have raised markers.

Your chiropractor is right in this scenario.

Found this on line-

PMR can be diagnosed with a normal ESR and/or CRP if there is a classic clinical picture and response to steroids. These patients should be referred for specialist assessment. The most characteristic presenting feature of PMR is bilateral shoulder pain and stiffness of acute or subacute onset with bilateral upper arm tenderness.

Perhaps you could go back to GP and maybe gently suggest to him that he trials you on a course of Prednisolone to see if that makes any difference.

[DevonshireDumpling1]

Hi Bodmor. My GP would not diagnose PMR, and would not refer me, because my inflammatory levels were within normal limits. I saw a rheumatologist privately and was diagnosed with PMR, being one of those patients who don't have raised inflammatory markers. So sorry you are having problems, perhaps there might be another GP in the practice who might be more enlightened?

[SlowboatToTheIslands]

I'm 65 years old and have recently been diagnosed with PMR by a rheumatologist. All my tests are 'normal' too.

🤪

[YuliK in reply to SlowboatToTheIslands]

What medication were you given ?

[Jane424 in reply to YuliK]

None. My GP said take more tylenol. Am already on tramadol for chronic back pain. I ave myeloma, so the worry is that the mew pain may be lesions. Am waiting for my hematologist to get back on that.

[Twinkling1]

Mine has always shown normal. Just tried treatment to confirm. He said if it works within 3 days I would know different.

[Rokerman]

I’d go along with Dorsey Lady’s idea - if it responds well to a course of Pred, then it gives you a pretty good idea what it is.......You might only get the lowest dose (15mg/day), which should give an improvement - mine had to be upped to 20mg to get full relief.

[PMRpro Ambassador in reply to Rokerman]

Response to pred only tells you that it is a pred-responsive polymyalgic syndrome! There are probably several so it isn't proof-positive that you have the PMR we go on about.

[KatiePr]

My CRP and ESR readings were only one point above the normal range so I would say that the readings are only an indicator. If you have the symptoms of polymyalgia then I would push for the steroids. Surely it's worth a try. I've been on 15mg/day for 4 days and so far I'm not really noticing any improvement. It does help when I take ibuprofen as well. Good luck.

[Trident58]

My blood tests were normal so one doctor ruled PMR out. So did a second doctor even though my symptoms immediately went away each of the 3 separate 10 day runs of prednisone starting with 20mg and the symptoms came back each time. After 6 months I called a retired internist that I had met on a few social occasions. I described my situation and he immediately said to find another doctor and tell him you have PMR. He also said I would probably be on prednisone for 1-2 years and maybe longer. I did but that one wanted to start me at 40mg even though 20mg was quite effective so I ditched him and the next doctor is working out fine. He lets me do the tapering I want to do without argument. I am using the one recommended on this site. Thanks again to DorsetLady. Keep looking until you find the right doctor. Best wishes!

[redyrun]

Hi , I have to concur with Dorset Lady’s post . I had the same question with my rheumatologist ie. normal bloods and was told that 20% of people with PMR have no elevated blood levels .