Increase in prednisolone dose????

[ipsidipsy]

I am in a quandary as to what to do. I had a telephone consultation with a GP (one I've never seen before) regarding blood test results. She said that my ESR was too high at 41 and that I should increase my pred dose to 40mg. I presently take 2mg. Although I explained that my ESR has always been on the high side during my journey with GCA (I've kept most if my test results) and that I didn't have any of the characteristics that I identify as a GCA flare, I have had GCA for 7 years so am quite familiar with them. I explained that when I take paracetamol if I have any kind of head pain it goes. In my experience paracetamol had no effect on GCA whatsoever. Nevertheless she insisted that I take 40mg. Any thoughts on this would be appreciated.

[SheffieldJane]

How very worrying. I am not medically trained and do not know the implications of a raised ESR result. However, every instinct tells me that your GP’s advice is extreme and your instincts are sound. I think I would be seeking a second medical opinion. You should be under a knowledgeable Rheumatologist for GCA. Good luck, let us know the outcome.

[ipsidipsy in reply to SheffieldJane]

In my experience finding a rheumatologist with experience of GCA has been a minefield, I did get one who seemed vaguely experienced but then he retired!!!! I have'nt seen one for about 2 years now.

[SnazzyD]

That’s a conundrum! I guess the first question is do you have any symptoms at all, even if they are not the usual for GCA? When and what was your last ESR and what have they coasted at.

[ipsidipsy in reply to SnazzyD]

Thanks for the response they usually range from 39 to 60 with no symptoms of GCA

[piglette in reply to ipsidipsy]

Mine is usually in that range too if not a little higher. My GP just puts Satisfactory against my blood test results.

[PMRpro Ambassador]

Ignore her - it would be totally inappropriate if you have no symptoms and that is either a single high result or in line with your historical values. A single raised value should NEVER result in a knee jerk raising of the pred dose unless there were any symptoms to match it.

ESR can be high for a whole range of reasons and some people just have an idiopathic raised level and given the figures you quoted to Snazzy, that is the case for you. You can go and join piglette on the naughty step - she has lunatic blood markers too

In the interests of manners though, do contact the practice and insist you get to speak to one of the doctors who is familiar with your case and situation and explain it to them.

[DorsetLady PMRGCAuk volunteer]

Take 40mg... for how long, and then what?

Seems a bit of a knee jerk reaction if you have no GCA symptoms alongside your high blood readings.

I can understand her reaction if she's new to GCA and you, but ESR can run high for all sorts of reasons, not just GCA, and if that's the norm for you, then a bit of common-sense and prerhaps more investigation from her is required.