Inflammation up

[Southmead]

As always when in doubt I reach out on this incredible tool for our PMR survival. I did my 3 month blood test, they took 7 samples in all. Everything was great, apart from the inflammation levels. The ESR was 19 mill over the norm, the CRP was 2.7 over the high end.

I was not surprised, we all know the symptoms of this disease. I have tapered down to 7mm a day, soon to be 6 mm. I am following the Swedish taper plan from H.U.

Other than fatigue, I am experiencing no other effects, no stiffness, etc. The fatigue has crept back during the last week. I have learnt from this site that you need to keep your adrenal gland going again, I am loathed to increase the Pred again. Sorry for long winded question, which is. How long does anyone think the fatigue during the taper is liable to last?

Thank you.

Peter D

[squashie]

It's hard to say Peter as we all seem to respond differently, and our take up of pred is quite individual. Following the mantra that "symptoms rule" it sounds as though you are beginning to give your adrenals a bit of a nudge - that could also explain the uptick in your inflammation markers. I was lucky and went through that level fairly easily, only to come unstuck trying to go from 2 to 1.5. I'm now sitting on 3 waiting to get brave enough to go back down again. I saw my GP today, and he's quite happy for me to stay around 3 for as long as I like.

If the fatigue is problematic, you might try a couple of days with an extra 5mg, and then drop straight back down again. Otherwise, and in any case, I would stay at 7 until you're through the fatigue.

BarryD

[Southmead in reply to squashie]

Thank you, on we go, the fatigue is nowhere near as bad as it could be..

[PMRpro Ambassador]

Is that ESR/CRP rising from its lowest level you have achieved? If so - that is a sign you have got to too low a dose of pred to manage all the daily production of the inflammatory substances and the inflammation is beginning to build up again. It may not be causing symptoms yet - but that often lags behind until it reaches a threshold, just like a dripping tap fills a bucket slowly but it only overflows when it gets to the top.

The fatigue could be due to the increasing inflammation or it could be due to the dose of pred being a bit lower than ideal and the adrenal function not having caught up yet.

You MUST remember you are not tapering relentlessly to zero, you are looking for the lowest dose that manages the symptoms as well as the starting dose did. However slowly you taper, you won't get past that without symptoms returning. I would say you may well have reached an interim station at 7mg. If you continue to force the reduction you may end up with a full blown flare of the symptoms and my advice would be to stop where you are for now and get the ESR/CRP checked in a month (at most) to see if the rising trend is continuing. If they are due to something else, a chest cold is more than enough to send them up, they will have gone back down. But if your dose is just s smidgeon too low - they will rise further,

[Southmead in reply to PMRpro]

Thanks, I will continue with my slow taper. The symptoms are nowhere near as bad as the first diagnosis of PMR. It looks like the ESR/CRP result is not from the lowest reading, so that's good, there is a spike this time around, as I get to more informed on PMR. I was not surprised by the spike. Looking for the lowest dose is a good way to look at it. I don't suppose 5 mm or less does too much harm to the body. Thank you..

[piglette]

If you are just experiencing fatigue it is probably your adrenal glands waking up. You really need to stick with it, as if you increase they will just get lazy and go to sleep again which means you have the same problem next time your try and reduce. My CRP and ESR are usually incredibly high often in the 100s. My doctors ignore it now as they don’t know why.

[Southmead in reply to piglette]

Thank you, I will indeed persevere, the symptoms are nowhere as a bad then this curse first arrived.