Confusion over inflammatory markers

[Hollieby]

My hubby is the PMR sufferer, can anyone tell him if you are still using ESR/CRP on regular blood tests. My doctors say they don’t use ESR anymore as an indicator, but having spoken to someone today, who suffers, their doctors only do ESR and not CRP?!!! Confusing.

[jinasc]

I cannot remember where I read this - but it did say CRP is a better indicator. Some one else will be along who might be able to remember where it is.

I add that I have been reading so many papers lately both on the net, computer and printed that I am not surprised about the failure of memory.

BTW Many years ago when I had GCA only, both GP and Rheumys went by CRP only.

[DorsetLady PMRGCAuk volunteer]

I think it may well depend on the preference of the surgery or the laboratory conducting the tests…….Not sure it really matters, so long as they are monitored, and don’t chop and change.

Both are usually tested at the diagnosis stage…my surgery did both for about a year, but then changed to ESR only, but that was a few years ago.

Sure PMRpro will explain the pros and cons of both shortly.

[Koalajane]

My doctor uses ESR

[PMRpro Ambassador]

Greatly disputed - and some hospitals have added plasma viscosity instead of ESR just to add to the confusion! But PV isn't widely available and most of the historical work was not done including it as a tool. Very helpful!

In the past, there was a study (sorry, don't have a reference) that concluded that the ESR provided the best monitoring tool for PMR. It is very non-specific, but so is CRP. The main advantage of CRP is that it isn't affected as much by a delay in doing the assay - ESR should be set up within 4 hours at most after the blood sample is taken. Whatever is used - absolute values are not of as much value as regular testing so that trends can be identified. Up to about 20% of patients have ESR and CRP values that fall "within the normal range" - but that doesn't mean they are normal for the particular patient. My normal ESR is low single figures. The range is up to 20 (some say 30) so if mine runs at 16-18 it is very raised for me but not apparent to a doctor without access to previous values for me. And I have never had a raised CRP related to PMR - I had one single raised CRP on a day when I had what was probably a really bad episode of atrial fibrillation (hadn't been diagnosed at that time) but when it was checked the following week, it was fine.

It doesn't really matter what you use - but single values are useless. they need to be monitored on a regular basis. And above all - symptoms always trump lab values!

[Hollieby in reply to PMRpro]

Thank you one all for your reply’s, about what hubby thought, basically if your having pain, your having a flare. As with most things around PMR it can be very confusing, and still nurses and doctors at our surgery don’t know much about it.

[Maudie19 in reply to PMRpro]

I have never had a positive ESR test but pred took away all the pains so they said I had PMR.

[PMRpro Ambassador in reply to Maudie19]

One attitude I suppose - but pred DOES work for other conditions that can appear very like PMR and it isn't a recommended means of diagnosing PMR. Usually other things are slower to respond - but the speedy improvement in symptoms does require the dose being used is enough in the first place.

[Maudie19 in reply to PMRpro]

I know and worry that I haven't got PMR but on steroids. Is it too late to have some other test?

[PMRpro Ambassador in reply to Maudie19]

Probably - the most suitable confirmation of PMR would probably be a PET-CT scan but the waiting lists are long as it is prioritised for cancer diagnoses in the UK - it is a very expensive device so only certain centres have them. Pred suppresses the signal - some people have had to stop pred to have one done because their doctor was sceptical. Only for the scan to confirm it is PMR after all.

But there should have been other tests done to rule out the other possible causes of the symptoms. ESR and CRP are by no means the only tests to be done. And if pred did give 70%+ relief in a week, it is most likely to be PMR is the other things haven't shown up.

Contrary to what some people have been suggesting - it isn't as simple as pred bad, no pred good. they wouldn't have given you pred if they weren't fairly confident, on balance they are very reluctant to use it.

[Maudie19 in reply to PMRpro]

Yes and my GP has always been in touch with me all thru the Covid time checking what dosage I was on. She is happy with me being on the DSNS taper. I sent her a copy of my spreadsheet I have done.

[MrsNails]

Many Rheumatologists prefer CPR Levels for PMR - when we lived in Wales the GP’s couldn’t request an ESR so that was only ever done at the hospital. However, they did do a Plasma Viscosity for MTX Bloods but that is not done now - l now live in England.

MTX Booklet

[Hollieby in reply to MrsNails]

Thank you.

[Blackcat1M in reply to MrsNails]

Hello MrsNails, your mtx recording book is different to mine.I have my bloods taken every three months this includes my PMR testing.

What I would like to ask you should I have my PMR tests more regularly my rheumatologist has never said anything but, I have wondered when I have had flares should it have shown on my blood tests early(I hope you can understand what I am trying to say as at the moment my heads all over the place)

Hope you are well

[MrsNails in reply to Blackcat1M]

Morning BC ~ l used to have my bloods done monthly but now every two months. However, if l am experiencing a Flare or struggling l ask to have my bloods done.

Usually l speak to the Rheumy Nurses first as the Nurse's at my Surgery always ask who’s requested them…..

When l first started MTX they were much keener on Blood Tests/Results but because of Covid they moved everyone who was stable to Two Monthly & l can’t see that changing.

When things are bit more settled I’d ring the Nurses to have a chat, they are very knowledgeable about MTX

Hope you & your husband are doing OK? Thinking of you

MrsN

[Blackcat1M in reply to MrsNails]

Thank you will do that take care

[Retallack]

I had ESR/CRP reading done as part of my diagnosis in 2019 and none since ! Started 15mg now down to 3/2.5mg. GP happy i know what I am doing and leaves me to it so me happy too !

[Bedwell in reply to Retallack]

Sounds great! My question which I’ve posted somewhere but can’t locate!! Is.. blood tests showed normal for esr and crp but abnormal for mcv and mch!! I wondered if anyone had had this result? And if it had any bearing on GCA symptoms. Because of my headache ( on top of my head) I’m a bit twitchy about GCA.. am on 12.5 mgs and can’t take half a mg less without feeling awful! Tried several times. So must accept to stay protem.

[PMRpro Ambassador in reply to Bedwell]

What is abnormal about the MCV and MCH? And how much out of range? Chronic illness can lead to anaemia and that can affect them. Can't think of any reason why they would affect GCA.

[Bedwell in reply to PMRpro]

Thanks. Will investigate further. Not hugely out of range.” Abnormal” maybe sounds worse than it is!!!

[PMRpro Ambassador in reply to Bedwell]

Not sure - but I think that when we are anaemic the MCV changes too. Just looked - it does, If they are smaller than usual that will also reflect in the MCH

labs.selfdecode.com/blog/me...

[arvine in reply to PMRpro]

sorry but what are MCV and MCH?

[PMRpro Ambassador in reply to arvine]

Mean cell volume and mean cell haemoglobin

If you were to try your search engine (i.e. google) it would have told you ...

[arvine in reply to PMRpro]

oh never thought of that, sorry,

[PuttyPenguin]

Totally agree with Madame Ambassador - symptoms trump every thing. I had an appointment with Professor Rod Hughes and he said exactly the same. He told me not to get too hung up on the results of CRP and ESR as they can rise if you have a cold. Your husband knows his body he should just monitor how he feels. Wishing him well.

[Hollieby in reply to PuttyPenguin]

Thank you.

[Pixix]

Yes, my recent blood tests showed ESR in normal range, but CRP was nearly double the top of the range number. But I don’t think it’s related to my PMR I think it’s due to back sciatica & hip & back trouble that I have at the moment. On diagnosis my levels were barely raised.

[Carriemetz in reply to Pixix]

Yep, me too. Am going by symptoms entirely, and by how I feel ‘in myself’ as they say. After three years of pred and no GCA symptoms after the third day’s 60 mg dose of the for-which-I-thank- heavens-every-day-prednisolone on March 27th 2019, I’m told I should stop my dose of 1mcg pred today, despite raised Cpr - not doing it! Will very gradually decrease and see what occurs when I’ve done the physio exercises and had another blood test in 6 weeks or so. 😳😉

[Pixix in reply to Carriemetz]

Sounds really sensible to me! Glad you are getting so low…I only dream about getting back down to 3mg again…but then I’m impatient where health is concerned!

[DorsetLady PMRGCAuk volunteer in reply to Carriemetz]

Good plan - please let us know how things go.

[Carriemetz in reply to DorsetLady]

I will.

[Seacat30]

Rheumatology in Brighton is. They tested mine about a month ago and found both normal along with the rest of my 'unremarkable' blood test results. I was surprised as I thought that I was being dragged off steroids too fast.

[Exflex]

CRP - a protein released by the liver, I’m informed - is quick reacting to any injury to the body by infection (not sure about physical, but I guess anything that causes inflammation will do it). ESR doesn’t ‘fade away‘ as quickly as CRP, I believe. My GP has been allowing me to schedule my own blood tests, which I usually have once a month. The reason being that my inflammation markers (both CRP and ESR) have been raised above the normal range for well over 18 months, but sill I continue to reduce my Pred dose based on symptoms (currently bordering on 4+1/2mg being part way a reduction from 5mg).

[PMRpro Ambassador in reply to Exflex]

Anything that damages muscle will increase it - including surgery and cardiac events. The levels post hip replacement can be astronomical!

[DorsetLady PMRGCAuk volunteer in reply to Exflex]

My ESR caused consternation in GP surgery following hip op (6 months after knee) - 3 years after GCA in remission. But a couple of weeks on steroids (thought Id finished with then) sorted it!

Also had high results during GCA -no symptoms but stress over late hubby’s cancer-long time to diagnose. So not always PMR/GCA.

[Alebeau]

I do monthly ESR and CRP and my Rheumatologist is good with that scenario.