Raised ESR, normal CRP

[CygnusX1]

Hi all you friendly folk in my phone. GP diagnosed PMR Dec 2021. ESR 58, CRP 13. (My records state my ESR was 40 in 2016 though nothing was said it done about it then). Started on 15mg and ticked along quite nicely getting down to 5mg, though never getting below 34 ESR .Hospital rheumy says it's not PMR and to taper down 1mg weekly to zero. Within 2 weeks and heading down to 2mg I was in pain and struggling. Blood tests showed ESR of 74. Put myself on 5mg but still suffering so upped it to 6mg. ESR decreased to 68. Rheumy says not PMR as the ESR would've reduced more and CRP is normal (though he didn't give me that figure). To add to the confusion I was diagnosed with smouldering multiple myeloma in May 2022 after the many blood tests for PMR highlighted raised white cell count. At present I have put myself on 8mg of pred due to pain/stiffness and awaiting next rheumy appt where he will tell me it's not PMR, meanwhile the myeloma nurses tell me the pain is not from the myeloma but PMR...can you have PMR with a raised ESR with a normal CRP getting nowhere fast please help!!

[PMRpro Ambassador]

Of course you can. You can have PMR with raised CRP, raised ESR, both or neither.

What is indisputable is that you have a pred-responsive inflammatory myalgia. What unreliable blood markers have to do with that is very disputable ... The ESR hasn't gone down further because you actually need more to clear it out.

Find a doctor without blinkers who treats the patient before them and not the text-book theory which isn't reliable.

[CygnusX1 in reply to PMRpro]

Thanks for the reassurance. I've voiced my concerns to the myeloma nurses that the pred may be masking the fact that it's myeloma causing these symptoms and they tell me it's not. They seem to be more knowledgeable than the rheumy so I'm going with that for now..I hope the rheumy is prepared for me as I'm going to be armed with questions and look to him to convince me it's not PMR - which so far he can't!

[piglette]

ESR can take longer to drop than CRP. How people actually feel is probably better than relying just on inflammation markers. The markers tend to just be an indicator and not necessarily definitive.

[Charlie1boy]

Hi,

Just as a matter of interest to you, I was diagnosed with multiple myeloma some two years ago, whilst still on prednisolone for pmr - around two mg at that time. The haematologist implied that it was possible for the symptoms of both conditions can be similar, and, as I was getting adrenal issues then, I couldn’t be sure which was which!

However, after an initial fright about the myeloma, this condition was downgraded to “smouldering”, and I feel it’s not causing any problems for now. I’m on six monthly blood checks, and the results have been stable. I had no problem with white cell count, but initially the paraprotein was a bit high, and the haemoglobin a bit low.I have not had to have any treatment for it, albeit they found cancerous cells in my blood plasma.

Hopefully, you get your pmr issues sorted out.

Good luck.

[Yellow-dog]

Hello CygnusX1

I too had raised esr and normal crp. Was told it couldn’t possibly be pmr based on this. After various other tests and nine months later , in lots of pain, I asked to be treated as if I had Pmr. The steroids brought instant results and doctors eventually conceded that I had atypical pmr. So yes, you can have pmr without raised crp. I do hope you feel better soon,

[PMRpro Ambassador in reply to Yellow-dog]

But as I keep saying - it ISN'T atypical. A study found ESR had a definite role in diagnosing PMR - and markers are only one of a load of signs and symptoms. You need both but even then, they are never the be-all and end-all.