GCA and elevated CRP

[Vikinga]

Hello All,

I had posted before my problems with CRP which was very variable fluctuating from 20, 40, 25, 23 not responding to increased prednisone dosage. This problem started immediately after I got Covid 19. in September 2024.

My CRP was 4.3 in August and increased to

7.6 on October 1st

20.7 on October 21st

42.1 on Nov 4th

20.3 on Now 18

28.3 on Dec 2

It has been in the mid 20s in January, February, March despite taking 20mg of prednisone for a month and 17.5 mg for another month

I do not have symptoms of GCA, no headache, no scalp tenderness, no jaw claudication just twinges on my head and close to my eyes that last a few seconds and then they are gone. My rheumy ordered a CT thoracic scan that hopefully could provide information on what is going on with my heart, (I have palpitations some days usually in the morning) presence of aortic and abdominal aneurysms. My cholesterol is 144, random glucose is low. My level of energy is low, I would not say is fatigue.

Liver enzymes are normal, glomerular filtration rate is 93. I have moderate diverticulosis but never had diverticulitis. Unfortunately the waiting period for a CT thoracic scan could be as long as 7 months. I talked to the rheumy today about the prednisone dosage during the waiting period, I was at 17.5 mg, he wants me to reduce it to 15mg/day for 3 weeks .

I have osteoporosis, and I had read that osteoporosis causes lots of GCA flares that are difficult to control, But I think I do not have flares unless those twinges are flares?

My concern is that if I start reducing the prednisone I can really have a flare?

Any comment will be really appreciated

Regards

Vikinga

[piglette]

Markers such as CRP can go up and down for many reasons, even a cold. Mine went up to 412 when I had a new hip, which rather panicked the surgeon and he kept me in hospital for nine days. In fact I felt fine. The real thing is how do you feel? It sounds like you are being looked after well. I would not reduce unless you feel OK. If you take things slowly and you do not reduce if you have pain problems things should be fine.

[Vikinga in reply to piglette]

Thank you piglette, I appreciate your answer.

[DorsetLady PMRGCAuk volunteer]

As piglette has said -and we also commented on it in previous post, inflammation markers whether ESR or CRP are non-specific . They only show levels are high -not why.

Where did you read osteoporosis can cause GCA flares?

As said, if you feel okay then reduce, but if you aren’t sure then don’t.

You could try a smaller reduction -if you have 2.5mg tablets and they are plain uncoated ones then you can halve them … or better still request 1mg size.

Maybe also use a slower tapering regime as often talked about on here..

healthunlocked.com/pmrgcauk...

[Vikinga in reply to DorsetLady]

pubmed.ncbi.nlm.nih.gov/251...

Hello Dorset Lady, Thanks for your reply. Above is the link to an article that indicates that GCA relapses are more frequent on patients with Osteoporosis.

I will reduce the prednisone dose to 15mg per day, I wish I could reduce it following your tapering suggestions but I am limited to the amount of prednisone my rheumy provides me.

Thank you again, Vikinga

[DorsetLady PMRGCAuk volunteer in reply to Vikinga]

Thanks for that - wasn't disputing what you said, but I haven't noticed any comments on here specifically relating to that, so was interested.

Would just say that the results are not that compelling, many of the patients may well have flared anyway - with or without osteoporosis...

Pity about Rheumy and a their attitude to Pred...afraid you're not alone in that!

[Vikinga in reply to DorsetLady]

I did not feel you were disputing that, you are extremely knowledgeable and I appreciate your interest in such information.

Today I reduced the 17.5mg of prednisone to 15 mg/day. So far, so good.

I will keep you posted.

Vikinga

[Lmnpmr in reply to Vikinga]

The paper only shows an association between those who flare and those who have osteoporosis. There is no suggestion of osteoporosis CAUSING flare. The most likely reason for the connection is that those who flare require an increase in pred dose each time so have a greater total dose of pred and therefore their bone health is poorer.

[PMRpro Ambassador in reply to Vikinga]

I think you have misunderstood that abstract - it doesn't say that osteoporosis CAUSES GCA, What it says is that osteoporosis is more common in patients with relapsing GCA - probably because they have taken a lot more pred and that has increased deterioration in bone density leading to osteoporosis.

[PMRpro Ambassador]

Even when there is correlation it may not be causation - and there are many different reasons for CRP to be raised besides GCA and PMR. The only reliable assessment is on the basis of your symptoms, blood markers are an added extra to possibly provide more evidence - but rising or not rising cannot be definitely asscribed to the disease process.