I had a rheumatologist appointment on June 14th last. My pred. dose was 1.75mg then & I was told to keep reducing as I was in no pain & some blood tests were taken including an ESR.
I received a letter today from rheumatogy dept saying my ESR was raised to 35 ( it was 45 at diagnosis) & that I may require long term immunosuppression to maintain remission of my PMR. It was advised that I now increase my pred to 5mg until I am seen at the hospital again & perhaps take Methotrexate to maintain remission. I am very reluctant to increase my dose nor take methotrexate as I am not in pain & apart from fatigue I feel well for my age 82. I don’t know whether to keep reducing ( very slowly) or take their advice. Any advice would be much appreciated.
The problem with ESR readings is they can be raised for a variety of reasons from a stubbed toe to a virus, to an operation - they are not specific to your PMR, it just shows there is inflammation in your body. Do you know if there is any reason for this?
Plus if they are raised, we usually suggest they be repeated within a week or two just it case it was a blip. Is that possible to arrange with GP surgery perhaps?
If you aren’t having any return of symptoms, and until/unless you can get another reading I can understand your reticence to increase Pred, and certainly to add in MTX.
Thank you. I can’t think of any reason why this is raised but it is a while since the test was taken (June 14th). I shall contact my GP to ask for another test & take it from there.
If it were me, I would, at most, take a week of 5mg and drop back to 2mg and see what that does to your ESR. It might not be the PMR raising it - have you had a cold or an injury?
I absolutely would NOT start MTX at that low a dose of pred. I know plenty of rheumies who would agree 2mg or less of pred is preferable to MTX for which there is no guarantee it would get you off the pred altogether. You KNOW pred works. MTX works brilliantly for a small number of PMR patients but for the majority it doesn't get them off pred altogether,
Prof Dasgupta told us in a webinar 2 years ago that he often keeps patients on 2-3mg longer term as it reduces the incidence of relapse.
Thank you. I haven’t had a cold or injury but it is a while since I had the test (June 14th). I shall get in touch with my GP to ask for another test & if it’s still raised, then increase my pred as suggested by the doctor at rheumatology dept. However, I certainly don’t want to take MTX.
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