Inflammatory markers ESR CRT

[Hankb]

I have been on prednisone for just over 2 years, I started on a dose of 20mg and have reduced to 6.5mg a day with no pain or issues other than fatigue. I visited my rheumatologist last week an she said my ESR was 11 and CRP 12.6, she then suggested I go to 20mg of pred for 4 weeks and then retest my inflammation markers. I 'm not to keen to go back to the beginning re pred dose. Any advice from the forum would be appreciated.

[SnazzyD]

I think I’d be asking for repeat test to see if there is a trend upwards and also for some thoughts about what other cause it could be in the absence of symptoms for you. These markers aren’t just for PMR as you probably know. Do you have any others issues it could be? It’s not uncommon for people here to have a ‘blip’ for no obvious reason or for the sample to be compromised by other factors.

[Hankb in reply to SnazzyD]

Thank you SnazzyD for your response. I don't have any known "other issues"other that I did mention to my GP,( who incidentally is very supportive and thorough in all respects and I trust her implicitly), that my legs felt hot as if they were sunburnt but when I touch them they felt normal. She said it could be neurological and would investigate it further saying that not everything is related to PMR. Maybe my "hot legs" could be an indication of something else.??

[PMRpro Ambassador in reply to Hankb]

I felt as if my skin was burning with PMR. And they were sore to touch.

[Hankb in reply to PMRpro]

My legs burn but are not sore to touch, so many side effects to this illness. Thank goodness for this forum where we can find out that we are not unique with the issues we have with pmr but others have also had similarv similar experiences.

[DorsetLady PMRGCAuk volunteer]

I would want more positive proof it was your illness causing a rise in readings -and they aren’t anything much to be honest.

and back to 20mg is overkill -10mg would be sufficient even IF it is your PMR

[Hankb in reply to DorsetLady]

Thanks DorsetLady. I have gone up to 10mg as I though myself 20mg was an overkill, I'm just a little bit concerned that I'm not following doctor's orders, rhuemy orders in this case. Maybe the hot legs sensation I have mentioned in my reply to SnazzyD may be related to something other than PMR, my GP wants to investigate that further after I completed the raised pred dose for one month.

[DorsetLady PMRGCAuk volunteer in reply to Hankb]

That’s fair enough to look at legs again -but just be aware if you are on (even) 10mg for a month you might struggle a bit trying to drop back down again.

[Hankb in reply to DorsetLady]

That's what concerns me, I've been tapering well so far and I don't want to compromise myself by pushing up the dose rate so drastically. I've been on10mg for only 2 days, I'm going to talk to my GP on Monday and discuss it again with her.

[DorsetLady PMRGCAuk volunteer in reply to Hankb]

okay- as PMRpro has said, 2 weeks at the higher dose is fine to drop back down easily, but not 4…

Lets us know how you get on please.

[Hankb in reply to DorsetLady]

I will definitely let you know after 2 weeks how I'm progressing.

[PMRpro Ambassador]

A single raised blood test that isn't accompanied by symptoms should never result in a kneejerk increase in pred - especially by so much for so long. The bloods should be tested a couple of weeks later to see if there is a rising trend - if there is you may decide it is a sign to increase the dose a bit but adding 5mg to the dose where the "flare" occured is usually plenty. ESR and CRP can go up a lot just from a really mild viral chest infection as in a cold, they aren't specific to PMR/GCA

Often if it is due to overshooting the dose you need at present, adding 5mg for a week or two and then dropping back to the dose ABOVE where the flare happened is enough.

[Hankb in reply to PMRpro]

Thanks for your responee PMRpro. My thoughts also is that the Rhymy's reaction was more of kneejerk than anything else. I've only increased my dose to 10mg from 6 to see what happens as 20mg also sounded to me a bit of an overkill. Having said that I'm trying my best not to be a Google doctor, as I have complete faith in my GP. I'm due to have bloodvtests in 4 weeks time.

[PMRpro Ambassador in reply to Hankb]

Complete faith in GPs may be a Very Good Thing. On the other hand, it can be misplaced!

[Hankb in reply to PMRpro]

She does go the extra mile for both my OH and myself and she goes to great lengths to explain in detail things. She's definitely 1 in a million as far as GP's go.

[SheffieldJane]

In the name of heaven WHY?

[Hankb in reply to SheffieldJane]

SheffieldJane. Thank you for your responee. That's just what my reaction was WHY. To jump to 20mg from 6 seems very drastic. My GP, however implied that there could be some other under lying factor other than PMR at play hence her referring me to the rheumatologist initially before investigating other causes.

[Nextoneplease]

Well, at the very least, I’d want to know the reason behind the advice to go up to 20mg! The rheumy doesn’t appear to have explained her logic…..

Also even if you stay at 10mg, if you do that until after your next blood test in a month, you’ll have to start a gradual taper again!!

You trust your GP. Can he/she explain this advice?

All the best to you 😊x

[Hankb in reply to Nextoneplease]

Nextoneplease. Thank you for your reply. I will contact my GP on Monday and re the increase in dose rate, until then I'll stick to 10mg. Tapering from 10mg is much less daunting than having to start all over from 20mg. 🙂

[PMRpro Ambassador in reply to Hankb]

If you get the bloods checked within 2 weeks you will be able to drop back. But a bit of patience and waiting a week to look at the course of the markers without a change in dose would be best.

[SheffieldJane]

I really wouldn’t want to rock the boat, you are doing so well. Can you get another opinion or a better rationale for the advice? Most doctors try to rush us off Pred.

[Hankb in reply to SheffieldJane]

Hi SheffieldJane. Thanks for your advice. I'm going to see my GP on Monday to talk through the ESR CRT results again, she's allowing me to manage my tapering plan (DorsetLady's plan) and thankfully isn't rushing me to get off preds. Armed with the advice from the forum I'll be in a better position talk it through with her. Many thanks.

[Hankb]

Thanks to everyone who responded to my query re increase in pred dose from 6.5 to 20 mg. The script I got from the rhuematologist was incorrect, I contacted her this morning to query the dosage and she said I should increase to 10mg and not 20mg a day for one month and then retest. Thanks once again for this forum which prompted me to query the rheumatologist. I suppose we are all human and do make mistakes, thankfully this matter has been resolved.

[DorsetLady PMRGCAuk volunteer in reply to Hankb]

yes we all make mistakes -but some are more serious than others!

Good job you queried it though

[Hankb in reply to DorsetLady]

For sure, I'm so greatful to you all on the forum, I don't know where I would be without you all.