Persistently high ESR and CRP

[Exflex]

PMR diagnosed Dec 2019; starting dose of 15mg Pred with usual tapering regime. Currently on 2.5mg. Current Inflammation markers as follows:

ESR since Feb this year (and currently) 35mm/h, down from 50+ last year.

CRP 16mg/L steady for the last 6 months, previous 6 months 21mg/L, but has been up to 45mg/L last year.

Previous GP wanted continued reduction of Pred. (I’ve moved recently, registered but have not seen a medic yet.)

What do you knowledgeable people think, and what to say when I see my new GP? It’s a dilemma in that I don’t want to be stuck on Pred, but clearly there’s something still going on.

[PMRpro Ambassador]

Irrespective of the markers - have you got symptoms? They are more reliable in PMR.

Some people do have persistently high markers - ask piglette! They can also be raised for a lot of other things besides PMR so are there any signs of anything else? Did the previous GP look?

[Exflex in reply to PMRpro]

No pain when I awake, usually between 7 to 8am and can wait awhile before taking Pred without issue (10am today). At bedtime I can get mild pain in the right bicep area, but this responds to paracetamol. (Adrenals would normally sort this if they fully up and running, which they’re probably not, but getting there.)

I had a scare a week before moving house, getting pain around the right hand side of my head, and above my eye brow. Consulting my GP she wanted me to go to A&E, and possibly have a TAB performed. Since the stress of the move has greatly diminished the pain has gone. I suspect the symptoms were stress related.

Apart from that I damaged a muscle, tendon or ligament on the outside of my right knee in December 2021 and although it’s better, it’s not 100% and can show the usual signs of inflammation if I overdo things. Ibuprofen helps calm the inflammation.

Finally the doctor did not perform any other checks when ordering the blood tests I mentioned, and really had to be pushed to agree to authorise measurement of the inflammation markers.

I’m thinking of staying at 2.5mg for an extra month (I’ve been on that dose for the last 3 months) and then attempt a slow taper to 2mg. I’m never going to find out if I don’t try it, but concerned by the blood results.

[PMRpro Ambassador in reply to Exflex]

I think the blood markers are relatively irrelevant in terms of PMR - go by symptoms. I have a left-over torn collateral knee ligament that protests a bit if I'm not careful - PMR definitely goes for weak points but if it doesn't last, I ignore it. If your markers had been lower at higher pred it would concern me - they weren't though, were they?

[Exflex in reply to PMRpro]

That’s right, the markers were higher at higher dose than they are now. I former GP said symptoms over inflammation markers.

[piglette]

I have always had high inflammation markers which go up and down, sometimes over 100. My doctors have decided it is just me! If I feel fine I try to reduce, if I don’t, I try and do something about it.