ESR reading

When I was diagnosed 7 weeks ago my ESR reading was 28 and marked in red as abnormal. My CRP was marked in green as normal. The GP who asked for these tests gave me a trial of Prednisolone that erased all the deep, burning aching in my muscles by the end of the day. On these results I got my diagnosis.When I saw an old school GP I was told this ESR reading was not high and the diagnosis was not definitely PMR.

Since reading this forum and speaking to my own GP I realise that it is PMR and is a carbon copy of the illness my late maternal aunt had.

Is an ESR reading of 28 high or not? I have not had any blood tests since then

[Koalajane]

it would be high for me as my usual reading is under 10. But at that level my GP once said 28 was normal but my nurse said she could see that it was higher than my previous readings of 9

[DorsetLady PMRGCAuk volunteer]

Sorry to sound boring, but as with many things it's not quite as easy as it sounds to say what's high and what's not. Two people might give same figure, but for one it's high for them and the other it's normal.

This is range often quoted -

What is normal range of ESR reading?

The following are considered normal ESR test results:

Women under age 50 should have an ESR between 0 and 20 mm/hr.

Women over age 50 should have an ESR between 0 and 30 mm/hr.

Men under age 50 should have an ESR between 0 and 15 mm/hr.

Men over age 50 should have an ESR between 0 and 20 mm/hr.

Plus different laboratories may have slightly different ranges.

see this for a bit more info-

healthunlocked.com/pmrgcauk...

[Hidden in reply to DorsetLady]

Not boring at all, I am learning all that I can. I guess it's all relative because the symptoms and instant reaction to Prednisolone along with family history all point to the diagnosis being correct. I tend to be a control freak with health anxiety who questions a lot, rather than taking things at face value Dorset Lady

[SnazzyD]

That would be very high for me as my ESR coasting value is 4. When my GCA was at its peak, it was only 16. The important thing is that they treated the symptoms and not the numbers. Your condition responded well to Pred so whatever the label, that’s what it needs and they can’t say unequivocally that it isn’t PMR based on your markers. Your “old school” GP might need to catch up on current ideas around PMR.

[Hidden in reply to SnazzyD]

Thank you SnazzyD. I like your dog 🐾

[PMRpro Ambassador]

Like Koalajane and SnazzyD, it would be very high for me as my normal is low single figures. And KJ's nurse was quite correct - it was very raised for her. Nurses are very good at spotting such things. Your old-school GP is wrong because it is acknowledged in the literature by the experts that it is possible to have PMR with normal range markers. But I imagine he learned about PMR many years ago and hasn't updated his knowledge since. Much has changed with regard to thought about PMR and GCA and it is now being thought of a spectrum disorder rather than individual illnesses.

ncbi.nlm.nih.gov/pmc/articl...

journals.lww.com/md-journal...

Of course, what isn't mentioned in these papers is the patients with PMR symptoms and normal markers who aren't diagnosed by the "old school GP" and are told it is just advancing age - as I was at 51! They aren't looking for it so don't identify it and we don't join the ranks of the PMR patients with normal markers. I think it is improving because you can become very disabled and in the end they do a PET-CT scan and lo and behold - there is the evidence of PMR with the typical inflammation despite normal range markers.

Part of the problem is a misunderstanding of what "normal range" actually means. The normal range is based on the range of readings found in a large population of nominally health people, 10,000 is a commonly used number. These are plotted as a graph and the area under the graph that includes 95% of the patients is declared the "normal range". 2.5% will be under that cut-off figure and 2.5% above it - but are still normal and healthy. And the normal range is not a range of readings that is fine for an individual - each of us has our own normal level. Mine is about 4-7 - it ran at 16-18 for weeks during a massive flare, but that is still well within the quoted "normal range" so no-one turned a hair.

Does this explain more?

[Hidden in reply to PMRpro]

Yes it does, thank you. At the end of the day my graph had a red arrow with upwards trajectory towards the number 28 and the word 'abnormal' in red. The diagnosis was made.

[sidra1968 in reply to Hidden]

I had the opposite issue, even as it raised to 32 while ON the Pred (fairly high dose, too), both the GP and rheumy said my ESR wasn't high. Even though a reading months earlier after a steroid pack, it was 6. I mean, they just aren't always correct, I have many examples of this.

[PMRpro Ambassador in reply to sidra1968]

What they are supposed to be looking for is a RISING TREND, not absolute numbers. It is hardly rocket science - where is their problem?

[Hidden in reply to PMRpro]

Maybe because they are general practitioners. They know a little about a lot of things whereas specialists know more about less things (and forum members too of course 😉)

[PMRpro Ambassador in reply to Hidden]

That is something any respectable GP should pick up on. And actually - a good GP is far preferable to a dodgy rheumy!!!

[Hidden in reply to PMRpro]

I stand corrected 🙂

[PMRpro Ambassador in reply to Hidden]

Not a correction - an observation. We do a lot of observing of poor medical knowledge one way and another ...

[EnyaBlue in reply to PMRpro]

I love your explanation of "normal range". As a retired maths teacher, I give you full marks. The word "normal" in itself means different things to different people. But the mathematical use applied to medical and pharmaceutical research has been hijacked. Normal for a "sample population" does not mean normal for the individual. My deceased father in law, a medic would get really irritated when doctors talked about of "evidence based" medicine when they were in fact practising "statistics based" . The evidence he would say is the patient in front of you who could be the 1 in 10 000 and its your job to find out.

[PMRpro Ambassador in reply to EnyaBlue]

Thank you - wasn't maths classes that taught me that though, it was a few years working in Clinical Biochemistry as a technologist and it was drummed into us. Made it difficult explaining to a less educated doctor why the result wasn't as bad/good as they thought!

[EnyaBlue in reply to PMRpro]

I can believe that. In this data and tech driven world you have to have a good grasp of maths to understand and interpret the stats in order to find out what really is important

[PMRpro Ambassador in reply to EnyaBlue]

So many of them are numbers-centric and think they are absolute gospel. But this is biology, not engineering ...

[EnyaBlue in reply to PMRpro]

I agree and recently tried to explain to my son who is a physics graduate that biology works differently when we were discussing carbs and calories in/calories out theory. Having said that I know nothing about biology and accept your superior knowledge in this field. Thanks

[PMRpro Ambassador in reply to EnyaBlue]

But you are quite right!!!

[herdysheep]

I have found it useful to keep a record of results of blood tests etc so that I can see any pattern developing and get a better idea of what is normal for me, along with a diary of how I feel.