An unpleasant surprise....

[Marinescience]

Hello all,

Following the sensible advice on this forum, I have been following a slow and cautious tapering of prednisone, and current at a very low dose of 0.75 mg/week (three 1/4 mg days and four days no Prednisone). My steps down per week were 0.25 mg/week.

I have been feeling generally OK, so much so that I have not had blood work done since May 19th, when the C Reactive Protein marker was undetectable. But today, it was 25 mg/L(normal range 1-2 mg/L ). A little surprising and disappointing, since I am not experiencing any other symptoms.

I realize CRP is non-specific for PMR, so I suppose other explanations need to be ruled out? Even so, would it be precautionary to up the prednisone dose to what it was when CRP levels were undetectable? That would be 1.5 mg day.

Thanks to this forum for their invaluable help, it is greatly appreciated!

[PMRpro Ambassador]

A single raised test for CRP and ESR doesn't mean it is the PMR and shouldn't result in a kneejerk raising of the pred dose if there are no appropriate symptoms as well. Both can be raised in response to minor infections like colds and CRP is particularly raised by chest infections. They can be raised due to injuries and even stress.

The correct thing to do is to get it checked in a week or so to see if there is a rising trend or if it is falling again. If PMR symptoms appear, then that suggests it IS the PMR.

[Marinescience in reply to PMRpro]

Thanks very much for the quick response -- good advice as always. I will recheck the blood work in a week or so.

[Marinescience in reply to PMRpro]

Hello! As you suggested, I "stayed the course" and had CRP levels checked again this morning, about 14 days after the last test (25 mg/L). The latest value is 29 mg/L.

So a slight increasing trend, and some symptoms are starting to re-appear (lack of energy, some soreness in pectoral area). Symptoms are not serious as yet, but worrisome. I guess the conclusion is that I have overshoot in my tapering of prednisone, and I should up my dose somewhat. I am also planning a trip to visit my daughter in New Zealand to see my daughter, who is an ER doc. I wish to avoid spending time with her in her ER!

I am currently taking 1/4 mg every second day. Because I was lazy in not getting more bloodwork done, I can only state that at 1.5 mg/day of prednisone, CRP was undetectable and no symptoms. I suspect that until recently, lower levels of Prednisone were effective as well but I don't have supporting bloodwork. I would be very interested in your recommendation for a new dose. I also notice that within the forum, an initial higher "mopping-up" dose is recommended. Would this apply in my situation as well? I will be speaking with my GP later today, but would value your insight based on own experience.

Thank you again for your time in answering these questions, and with best wishes.

[PMRpro Ambassador in reply to Marinescience]

If it were me I'd up that dose - 1/2mg per day would probably be enough ongoing To start with - perhaps a day or two of 5mg would be plenty to get you back to baseline. Difficult to say with you being at such a low dose. You may even get back to 1/2mg every second day.