Bloodwork result inquiry

[1951grumpa]

I’d like to get your thoughts on a couple things. (PMR Since 2011) I’ve been on Kevzara since late December . Had bloodwork after a month all was my normal. Then started reducing steroids 1mg/ week. Last week on 3 mg prednisone had blood work done. I haven’t heard from my Dr. yet. One result that concerns me is the WBC. In January it was in the normal range and now it’s 3.1. Normal is 3.8 -10.8…. It has never been that low. I am aware that Kevzara can lower the WBC but am wondering if that is too low….. I also had a morning cortisol test. My morning cortisol was in the normal range, 8.3 in a 4.0-22 range. There is on other thing, not sure if related to my PMR. I’ve had a sore hip since mid January. I’m pretty sure is some sort of bursitis or tendonitis. At times it get very painful to get up off a chair. I have been icing, stretching and using a diclofinac cream with some improvement.

[piglette]

With your hip, have you tried an analgesic to see if it helps the pain? I am sure your doctor would contact you if they were worried about your readings.

[PMRpro Ambassador]

Is that normal bloods after a month of Kevzara? Use of the other IL-6 inhibitor tocilizumab results in the ESR and CRP falling to normal levels very quickly - but this in NOT because the disease per se is under control but because of the way it blocks the inflammation being created and it is clear in the literature that they cannot be used to monitor disease status. I assume that is also the case for sarilumab/Kevzara.

Did the blood test include what is called a differential count - figures for all the different white blood cells as well as a total? Sarilumab can cause neutropenia - one of the types of white cell and that will also affect the total count. If you are developing neutropenia then you are at increased risk of infection and it needs close monitoring.

Yes, that sounds very like bursitis - I am on Actemra and pred and the Actemra doesn't keep the trochanteric bursitis and other tendinitis under wraps. You may be lucky and your current measures work but I need the occasional steroid injection for more targeted management. PMR seems to feed bursitis despite medication!!

[1951grumpa in reply to PMRpro]

Thank you for your reply. The first blood tests I had were after a month. The most recent are after 3 months. I was thinking the same re:the inflammation markers and the sarilumab yes. No differential count in the blood work…. I did receive an email from my doctor saying that she’s pleased with my blood work results. She is Not surprised that the wbc is a little low. She wants to monitor this closely so she’ll order bloodwork in a month rather than in another 3 months. Also I’m to hold my prednisone at 3mg until I get am mri of my hip. That’s scheduled in a few weeks when we get back home near Chicago. We are in South West Florida now.

[PMRpro Ambassador in reply to 1951grumpa]

That sounds positive - wonder why she doesn't order differential counts while she is at it.

[1951grumpa in reply to PMRpro]

Not sure. I can ask her next appointment