I am on 0.5mg pred and feel much better-why is my ESR 48?

[kangaroojohn]

I began pred in May 23 2023 and have had no pain symptoms since then. I am now down to 0.5mg pred.

My latest CRP shows " less than 0.5mg/dl" as it has consistently. However my ESR shows 48 mg/hr (normal 2-37), whereas previously it was 22, 24, 40, 12 and19.

I feel much better- the mood swings, light-headedness and awful fatigue having departed and I had been hoping to quit the pred in a couple of weeks.

I see the rheumy mid-Jan and have an attentive GP.

My questions are please:

(1) What could be the significance of this suddenly high ESR?

(2) Can I perhaps disregard the ESR reading (with my GP's agreement) and keep on the 0.5mg for another 2-3 weeks then stop?

(3) Should I just keep going on 0.5mg?

(4) When should I have another ESR test?

Thanks so much for all your work on here.

[DorsetLady PMRGCAuk volunteer]

ESR can be raised by many things -from a stubbed toe, a virus, stress to post operation.

I discovered this -once during my GCA (no flares, no issues-but in hindsight stress over late husband's health) and again long after GCA in remission but following 2 replacement surgeries within 6 months of each other.

If you cannot pinpoint it on any occurrences (however minor) then maybe just monitor it.

[SnazzyD]

You could ask for another test. One anomaly is not reliable information, especially in the absence of any symptoms of concern. Laboratory mishaps do occur and a second test will give a bit of an idea of any trend be it up or down.

[PMRpro Ambassador]

A single raised ESR without accompanying symptoms should never result in a kneejerk increase in dose. The correct procedure is to repeat the blood test in a week to 10 days to establish if there is an upward trend in the level. If there is, it would possibly suggest a flare (though not necessarily). If, on the other hand, it hasn't risen or has fallen again then it is more likely another cause. All sorts of things can increase ESR.

[kangaroojohn]

Thank you for these three very helpful replies. I will make an appointment to see my GP and incorporate the advice in them

[readingbooks]

Have you recently had a flu or Covid vaccination ?

[kangaroojohn]

I had a flu jab on 9th October.....some time ago?

[Bedwell]

people have been congratulating me on reducing to 1mg … every day at the moment… so I’m saying well done to get to 0.5!! Am feeling pretty exhausted I must say.. alternate days seem worse which seems strange! So should I be having tests for adrenal function?! Gp who rang yesterday .. (routine check for medications… ) said she couldn’t arrange for that .. must be rhreumy… not so easy to get app unless private. Also said bloods were ok in March so no need for another.?!?! Think I must try to see another GP.. ?! ?!? Goodness! What would we do without this forum??? Go barmy?!

[PMRpro Ambassador in reply to Bedwell]

Your GP can do a simple blood test for basal cortisol - the cortisol level in a blood sample taken between 9am and 1pm. That will give you half the result of a synacthen test and will show how much cortisol you are producing which is a fair indicator of adrenal function. If they don't know how to interpret it, we do and can provide them with the study backing for it.

[Bedwell in reply to PMRpro]

Thanks. Will talk to a different gp anyway!