Should I take daily prednisone dose before CRP test?

[Donna5658]

I seem to be having a PMR flare. I am getting a CRP and Sed Rate test today and wondered if I should withhold my prednisone dose until after I have the test? Thanks!

[PMRpro Ambassador]

When is the blood test due? Will you have taken the pred long before?

[Donna5658 in reply to PMRpro]

Because I take thyroid medication and because it works better to separate the two medications, I have been taking thyroid around 9am and prednisone around noon. This has worked well for the last year. Now I am having a return of PMR symptoms. I am on 4.5 mg.

So to answer your question, I was planning to do the blood test around 11am, which means the draw would be before my noon dose.

[PMRpro Ambassador in reply to Donna5658]

Sounds perfect. You know you can take the thyroid meds before bed? Even said to manage function better.

[Donna5658 in reply to PMRpro]

Thanks PMRpro! Unfortunately, because I take a kind of designer combination of Armour Thyroid and Synthroid, the T3 in the Armour is too overstimulating to take before bed.

[PMRpro Ambassador in reply to Donna5658]

Fair nuff ...

[Donna5658 in reply to PMRpro]

So I got almost instant gratification at the University of Washington lab today. My CRP is 3.6 (normal range 0 to 10). What’s puzzling is I have had a return of original symptoms (pain in neck, bilateral shoulders and a bit in thighs) but at much lower intensity than at diagnosis 14 months ago

I have been tapering to 4.5 mg prednisone for five weeks using DL’s schedule. I have now been at 4.5 for a full week but am afraid to go any lower. Wondering how to proceed as this certainly feels like a flare. Lots of stress, mostly good stress, the last two weeks.

Finally, my creatinine kinase was low. My muscles have definitely antrophied over the course of the year with PMR/prednisone even though I walk 3 miles 5 days a week. Looks like I need more strengthening/stretching exercises.

Thanks in advance for any suggestions!

[PMRpro Ambassador in reply to Donna5658]

In PMR the CK should be low - if it is high it is more likely to be myositis.

I think it is just the dose is too low - there has to be enough inflammation for long enough before the liver makes the proteins that raise the markers. And some people just don't have this response when they are on ANY pred. I'd try a couple of days of adding 5mg and see what happens. If that helps, go back to 5mg.

[Donna5658 in reply to PMRpro]

Thank you! You are incredibly helpful and make a HUGE difference in our lives by being so knowledgeable. Really can’t thank you enough.

[Donna5658 in reply to PMRpro]

Just a quick update. I have been on the raised (by 5mg) dose for almost a week and my symptoms have decreased considerably. However, my neck is still minimally sore, as are my shoulders. Neither is very noticeable or limiting.

I would like to drop back down to 5mg or even do a two-step reduction to 7.5 and then back down to 5. Does this make sense or should I stay on 10 awhile longer?

Thanks!

[DorsetLady PMRGCAuk volunteer in reply to Donna5658]

You can stay for up to 14 days without impacting your return to lower dose… so maybe give it a few more days especially as you still have a few niggles… if you don’t clear them completely they are likely to return.

[Donna5658 in reply to DorsetLady]

Thanks! Is it okay to drop straight back down to 5 after a few more days? I was on 4.5 when the pain returned.

[DorsetLady PMRGCAuk volunteer in reply to Donna5658]

Yes, and agree with PMRpro’s comment re neck.

[PMRpro Ambassador in reply to Donna5658]

I'd give it another couple of days and then start to drop back. Make sure that neck is better.

[Donna5658 in reply to PMRpro]

Is it okay to drop straight back down to 5mg after that? I was on 4.5 when the pain returned? Thanks!

[PMRpro Ambassador in reply to Donna5658]

Yes, should be. It is still within 14 days.

[DorsetLady PMRGCAuk volunteer in reply to Donna5658]

What’s puzzling is I have had a return of original symptoms (pain in neck, bilateral shoulders and a bit in thighs) but at much lower intensity than at diagnosis 14 months ago

Not really a puzzle, both steroid withdrawal [for some patients ] and certainly a flare feel like that.

Although your CRP is ‘within normal levels’ there are a number of reasons why they don’t tell the full story -

1. it is being kept low by the steroids,

2. even if it begins to rise because you are flaring, it can lag well behind your symptoms, and

3. in a study linked in another post today a comment regarding relapses, this comment - CRP levels were elevated in 62% of cases. So if you are in the other 38% yours won’t be.

If you think it is a flare - then this link contains advice on how to deal with it … and even if it’s not, I would stay on current dose for a few more weeks, or as PMRpro suggest just increase a little … no rush, 14 months is not that far into PMR lifespan….

healthunlocked.com/pmrgcauk...

[Donna5658 in reply to DorsetLady]

Thank you!!! All of this is helpful.

[Marinescience in reply to Donna5658]

I have found an excellent yoga teacher who offers specialized classes focussing on various objectives, such as improving mobility. As a long-term PMRer and someone with OA in the knees, I find such gentle exercise helpful and it supports my ongoing hiking (spent a few days in your neighbourhood -- Mount Rainier -- and had great hiking).

I was curious about your comment for normal range of CRP. In BC, the normal range is considered 0-2 mg/liter. Is it a difference in units? I am particularly interested since my CRP has recently dropped to 7, even when following a slow taper of prednisone.

Thanks, and good luck

[DBE46 in reply to Donna5658]

Why do you take them seperate. I would never know what my thyroxine is doing. Intrigued was this on medical advice xx

[Pr0jection in reply to PMRpro]

Hi PMRpro, I'd like to ask something similar. I take my prednisolone around 0800 just after breakfast. I have blood tests every two months around 1130 to check my CRP and Sed Rate. I've always wondered if I should hold off taking my morning dose until after my blood tests. Would it make much difference to the result do you think?

[PMRpro Ambassador in reply to Pr0jection]

Actually, I don't see the point of worrying since the idea is to assess how well your medication is managing the ongoing inflammation. The numbers are relative really - symptoms are far more important and should be taken in conjunction with the lab results.

[Pr0jection in reply to PMRpro]

Thanks!