ESR and CRP slightly raised, neck, shoulder and legs a little stiff, back too. How much should I increase Pred by?

[Dochaz]

My inflammation markers are on a slightly upward trend (ESR up from 17 to 20 and CRP up from 7.6 to 8.1 and I've been feeling more stiff in neck, shoulders (especially on the left) over the last few weeks. Should I treat this as a flare and increase Pred by 5 mg for a week or so? I'm reluctant to go back up again. I was very happy to have got down to 2 mg. But I'm assuming that sitting at 2 mg is not enough at the moment. Could I increase to 3 mg or is that not going to mop up the inflammation?

I know the flare protocol, but is this slight increase in inflammation enough to be an actual flare?

[DorsetLady PMRGCAuk volunteer]

Unfortunately you won’t know if an increase to 3mg is enough until you try.

So try that for 4-5 days -and if it’s doesn’t work then you may well need to follow usual flare protocol.

Good luck…

[piglette]

Personally I always think increasing by 5mg for a week to really knock the PMR on the head is better than going up a small amount which might or might not help. You can always drop back again say in two steps rather than letting the PMR win.

[PMRpro Ambassador]

It is the rising trend that is the warning sign - and if you leave it, it will continue. You certainly need to go back to 3mg - whether that is enough remains to be seen, Even a few days at plus 5mg might be enough this early - but do NOT let it get away from you or plus 5mg won't be enough. And that is exactly what you don't want.

[Dochaz in reply to PMRpro]

I decided to go up to 5 mg today and this evening I already feel less stiff. So 5 for a few days as you recommend. Thanks also Dorset Lady and Piglette for your advice and happy festive season!

[DorsetLady PMRGCAuk volunteer in reply to Dochaz]

Fingers crossed it works…

[PMRpro Ambassador in reply to Dochaz]

Sounds like a plan - but don't be in denial if it isn't quite enough!

[singingloud]

Here are my latest test. My PA said it was okay to stay at my new dose of 7,5mg of prednisone. But he also gave me the choice of increasing my prednisone since my morning stiffness last several hours and my pmr pain in my shoulders and hip girdle increases at times. Do you think I’m heading for a flare?

Blood test

[Dochaz in reply to singingloud]

I'm no expert! Dorset Lady and PMRpro will be better able to help, but it does look like a steep rise in CRP which might mean you need to increase your Pred for a while.

I spoke to my Dr this morning and he has told me to go up from 2 mg to 4mg and stay there for a month, after which he'll check bloods again and advise.

[singingloud in reply to Dochaz]

Thank you for your response. We will see how the days ahead will be like.

[PMRpro Ambassador in reply to singingloud]

There are 2 parts to that graph - what are the 2 figures in Jan and Oct 2021? Your lowest reading attainable on pred is what you should be aiming to stick fairly close to, it is the nearest you are likely to get to YOUR personal normal level. The 5 to 7 range you have been at since then is not too bad, it isn't continuing to climb significantly but that Dec 2023 level is not normal for you.

HOWEVER, the big difference means one of two things and it is imporant to establish which it is. Either you are developing a flare and the inflammation has slowly been climbing over the last 6 months OR you have another source of inflammation which is sending the CRP up. It is a very non-specific marker and any sort of inflammation will send it up, it could be PMR behind a chronic effect or it could be a cold or other infection which has suddenly sent it up.

To identify which it is, you need to have another test done in a week or two and see if it is rising or steady/falling. A chronic underlying cause will lead to it going up further, an acute underlying cause should start to fall, A raised CRP/ESR that isn't accompanied by increasing symptoms of PMR should not result in a kneejerk increase in pred dose because it could well be some other unrelated cause.

[Dochaz in reply to PMRpro]

This is for Singingloud, but in response to your reply PMRpro. I had a CRP result of 29 a couple of months ago but I had just had an episode of food poisoning (or maybe a virus, not sure which), but it came back down quickly afterwards, so don't rule out a cold virus or an unrelated infection as an explanation for the higher level of CRP

[PMRpro Ambassador in reply to Dochaz]

Exactly!

[singingloud]

January and October 2021

Second page

[PMRpro Ambassador in reply to singingloud]

Didn't quite mean that - how do those dates relate to your PMR and pred management?

[singingloud in reply to PMRpro]

In July of 2021, my prednisone was at 15mg because I was facing my first back surgery. My pmr symptoms were holding at about 90% good.

In March of 2023, I was at 9mg of prednisone but I extreme pain from my need to have back surgery because the other had failed and the spacer had fallen off my spine for who knows how long.

After several months of recovery I began my taper to where I am today of 7.5.

I fully understand that other things such as viruses can affect the number. That’s why I will hold where I am but certainly wanted your advice.

I hope I answered your question.

[PMRpro Ambassador in reply to singingloud]

My opinion is that your personal CRP should be down about where it was then, July 2021, and it has been edging up over time to levels that are in any analysis high. But first you need to establish is this PMR or is it something else - and I;m not sure how much more you should be reducing as your CRP is on the high side.

[DorsetLady PMRGCAuk volunteer in reply to singingloud]

As PMRpro says you need another test - to see if latest one was just a blip… if it’s gone back down again it may have been just that - and it’s probably okay to reduce… provided you feel your PMR is under control.

If it is same or higher, then as explained your inflammation has risen, whether that is due to PMR or somethings else who knows… have you had a cold, virus, minor bump or issue anywhere that could cause body to react?

[singingloud in reply to DorsetLady]

I’ve had a stuffy nose off and on for months. Two weeks ago I believe I had food poisoning that only lasted a day. Three weeks ago I woke with vertigo which passed in two days after seeing the chiropractor and taking only one antivert pill.

[DorsetLady PMRGCAuk volunteer in reply to singingloud]

Tht certainly could count for rise in readings…. But still might be useful to get another test before you reduce…and I’d hold off doing that for couple of weeks anyway, I never tapered around Christmas….

[singingloud in reply to DorsetLady]

Thank you for your wise counsel. I’ll maintain the 7.5 and in three weeks I’ll see if pmr pain has increased or settled down and request another blood test. My PA is very open to suggestions. Thank goodness. Have a wonderful Christmas to all.