Confusing Lab Test Results

[Donna5658]

I had a recent PMR flare that necessitated my temporarily going up from the 5mg I had tapered down to to a much higher dose. 20mg for 2 weeks, followed by 15mg for one week and then a drop to 10mg, where I have stayed for almost a month before I resume DL’s slow 5 week taper. Fortunately, my increased symptoms have resolved.

I just had blood test results which confused me. My Sed Rate was 2, well within the normal range but my CRP was still somewhat elevated at 6.7, with the high end of the normal range being 3. This was a test that I ordered myself and it turned out I inadvertently ordered the cardiac CRP, which is reported to be more sensitive than the regular quantitative CRP, which seems to have a wider normal range.

My question is, after one has had a major PMR flare, is it usual to continue to have a somewhat elevated CRP or should it be back down in the normal range as soon as the dose is raised? This did happen after I was diagnosed and started on 15mg of prednisone. After a month of pred, I was solidly back in the normal range from a high of 67. The only factor that might have affected my CRP this time around is I had my blood drawn before my daily dose of pred would have had a chance to be fully absorbed.

Thanks! Any input appreciated.

[PMRpro Ambassador]

I suspect it is a bit difficult to tell if you requested hs-CRP instead of CRP. An hs-CRP above 3 indicates a risk of cardiovascular disease in the next 10 years - but is likely to be elevated if you have an autoimmune disorder that involves inflammation, It is a bit like looking for a tree in a wood! The high sensitivity but means it is a test that can identify smaller changes in normal range CRP levels. It is only relevant in people with normal range CRP.

thecardiologyadvisor.com/dd...

[Donna5658 in reply to PMRpro]

Thanks PMRpro. I was mostly wondering if it is unusual to continue to have an elevated CRP after a flare once you have raised your dose sufficiently to control the inflammation. Does CRP take awhile to head back down to the normal range or does it happen right away? I’m wondering if my dose at 10mg is high enough to suppress inflammation?

[agingfeminist in reply to Donna5658]

decide your dose on symptoms...it is much more reliable. If you don't have PMR symptoms on 10 mg that's all that matters...you could even begin to taper very slowly and watch for symptoms.

[Donna5658 in reply to agingfeminist]

Thanks! This makes sense.

[PMRpro Ambassador in reply to Donna5658]

It depends, normally it should fall quickly in an acute situation, PMR is chronic. But CRP can be raised due to all sorts of things and while it is a useful monitor, it is not written in stone. As agingfeminist says - symptoms rule.

[Chiqui1950]

Hello Donna, I think it is great that your body has responded so well to the prednisone treatment. As you said, your sed rate of 2 is excellent and your symptoms have resolved.

I have had similar situations. when my CRP was high with a high sensitivity CRP. it is really important to retest with the right type of CRP. It is also possible that these high CRP results are a fluke, because your Sed Rate is normal. (the same happened to me, and my doctor was right, it was a fluke, I retested and my CRP was normal and I resumed tapering). However, if the results are close to 6.7 or higher than 3, I did not taper, I waited two weeks and tested again. Almost always, two weeks makes a big difference and I could retake tapering again.

For me tapering by 5 mg would be too much, I would go down to 7.5 mg. instead of 5 mg. and observe how are my symptoms. Perhaps others with more expertise than I, could suggest the best course of action as you retake tapering.

In my own experience, my Sed Rate and CRP levels are usually together, if one is higher than normal, I waited two weeks and retested. In my case, the CRP levels go down pretty much with the Sed Rate levels.

For me also, I try to have the same time and routine when my blood levels are taken. However, when this has not been possible I have not found a noticeable difference in my test results.

I see that the experts on this forum are sharing already. I have been helped so much by PMRpro and many others that I go by what they say.

All the best, as you watch for potential symptoms and are able to retake tapering one day at a time.

[Donna5658 in reply to Chiqui1950]

Thank you for your very helpful reply. It helps to know others have experienced something similar with lab results. I’ll wait a couple of weeks and then have the regular (quantitative) CRP redone. I’m really grateful they have these tests that one can order oneself as insurance might balk at reimbursement if the testing interval is too short. The prices for order yourself tests have come way down and they use the same lab my doctor uses. Thanks again for taking the time to reply!