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PMR

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Can anyone help with explaining the different readings between ESR and CRP.  For instance my ESR can go down to 34 (ref 1 -35)

from being high at 79 and my CRP is H 38.6  mg/l  (ref: 0.0 - 5.0), from being high in the 80's 4 months ago. I realise CRP is inflammation marker.  What I am asking,  what is the difference between a lower ESR and having a high CRP on same blood test?  or what could be the meaning of this?

My Dr could not explain this to me, maybe it makes little difference having one high and one low etc.

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1 like, 30 replies

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  • EileenH
    EileenH track

    Posted

    They are both totally non-specific indicators of an inflammatory process going on in the body and actually I'm not surprised your doctor couldn't explain it - I doubt most people could! 

    ESR is measured by seeing how fast the red blood cells settle to the bottom of a tube - sedimentation rate - and it increases because various proteins coat the red blood cells and make them slippier. CRP (C-reactive protein) is one of those proteins the body produces in response to inflammation. 

    In fact - some people don't get one or the other (or both) increasing even in inflammatory diseases, mine have never budged from "normal range". A normal range of 1-35 is actually a bit old-fashioned, it is now thought that anything above about 20 suggests there is something going on. So if your "personal normal" is in single figures - it may be that 35 is still pretty high for you. Are you PMR symptoms all under control? Which is what is really important.

    However - are they absolutely sure about the PMR diagnosis? I saw something recently suggesting a persistently raised CRP can be found in some autoimmune disorder or other - but having said that, I can't remember what it was. Mea culpa... 

    • EileenH
      EileenH

      Posted

      And I also have found a paper about a patient with a high CPR that was actually decided to be interference from something else in the testing! She had been investigated for 8 different other illnesses before that!
    • track
      track EileenH

      Posted

      Thank you Eileen I was waiting for your response, new you would have the correct response.

      My PMR is now quite under control, only very small niggles in my legs and I have so much more energy now.   Down to 7mg Pred. with the slowly does it method which has been very successful.

      Thank you,

      Track

    • track
      track EileenH

      Posted

      I am still having abnormal FBC's, seeing Haemotologist  in a couple of weeks, this could be interfering as well with CPR results , I am having monthly FBC until I see the Haemotologist.

    • track
      track EileenH

      Posted

      WCC and Platelets go up and down, neutrophils H, Lymphocytes L, Monocytes H, RDW High, MCHC L, MCH L,  Dr is hoping Prednisone is doing this, have had this problem for the past 6 months.  I am down to 7mgs of Pred. now, hoping to reach 4mg in a few months.  No problem with my FBC when on high Prednisone only when lowering did it occur.
    • EileenH
      EileenH track

      Posted

      Which suggests there might be some form of inflammatory thing going on that the pred is sorting at high doses. Bizarre - hope they can identify what it is.
    • track
      track EileenH

      Posted

      EileenH and Ladies,

      I had visit with Haemotologist yesterday very interesting.  She wrote down info and said I could pass this on.

      "Combination of REACTIVE abnormalities, blood abnormalities discovered 2 years ago when I was very sick with PMR/GCA, inflammation.  REACTIVE abnormalities in blood - High Platelets and High White Cells , Platelets gone down as PMR better now but white cells remain up with Prednisone and any sickness.  Dr said Platelets do not go up with Prednisone.  She does not think she will find a Primary blood/marrow problem but blood abnormality could be in sympathy with inflammation.  For completeness has ordered 24 extra blood tests one of them being Genetic blood testing."

      I will have results from these blood tests in one half weeks.

      My worry is when I posted on this site awhile back,  if others had abnormal full blood counts while on Pred. and having PMR, there was no answers.   most of my bloods are abnormal and still are - Leucocytes, Monocytes, Neutrophils,  etc....

      Will let you know outcome of these extra blood tests.

      I am now down to 5.5mg of Prednisone, Haemotologist  told me not to go down any further at the moment.

      I see Neurologist re TIA April 22nd.

      hope you are keeping well.    Track

    • EileenH
      EileenH track

      Posted

      To know the GP would have to be requesting a full blood count every time they check. But we know that most don't - you are often luck to get an ESR/CRP done! 

      On the other hand, I do know there are a few people who DO have FBCs done and I have never heard anything more than neutrophils (and total white count) being high - which is usual.

  • MrsO-UK_Surrey
    MrsO-UK_Surrey track

    Posted

    Track, two tests carried out in different ways but both reacting to inflammation in the body (they can go up and down at the drop of a hat, for instance with chest infections/viruses etc), and it seems that your ESR has returned to normal whilst your CRP is lagging behind.  Many medics consider the CRP to be a more reliable marker of inflammation, and certainly in my experience, my CRP numbers often tended to lag behind the ESR during my PMR/GCA days.  The inmportant thing is that your markers are heading in the right direction, so just ensure that you keep having the tests repeated, and certainly before each and every steroid dose reduction, to ensure that the readings remain on a downward spiral.
  • Anhaga
    Anhaga track

    Posted

    Ah, this might explain why my doctor selected to regularly check only ESR, not both.  
    • Guest
      Guest track

      Posted

      Hi. The way it was explained to me was that the ESR for some, gives a further look into the future compared to CRP. This is helpful if you can't decide whether aches and pains are flares or not, if ESR is falling hopefully they are not !

       

    • EileenH
      EileenH Guest

      Posted

      Strange idea - since both are based on past events!
    • Guest
      Guest EileenH

      Posted

      A good point Eileen !  Maybe better to say that the ESR is more current and CRP takes a bit longer to 'catch up' with state of play ?

    • EileenH
      EileenH Guest

      Posted

      Not necessarily - it also rises quickly in some cases. They are both so non-specific they are only very rough guides anyway.Unfortunately some doctors take them as gospel!
    • Guest
      Guest EileenH

      Posted

      As everyone says, we all respond differently but so far my levels seem to follow this pattern. Hope I'm not tempting fate

    • EileenH
      EileenH Guest

      Posted

      What is most important is to establish how they work for YOU - YOUR normal range, your signs and symptoms. Some people have symptoms long before the bloods change, others never have a change while still on pred - and mine simply never changed! Normal ESR is 4, it did once reach the dizzy heights of 7. CRP never changes.
    • Guest
      Guest EileenH

      Posted

      Thanks...No wonder we need this forum, I now wonder if I am right to ignore day long small to moderate muscle pains? Have never had the tiredness people talk about either ! I basically ignore the symptoms and am currently 10/11mgs alternate days for next 2/52 
    • EileenH
      EileenH Guest

      Posted

      If they are livable with and don't get WORSE as you reduce it's probably fine. By no means everyone is pain-free - but once things deteriorate on reduction then it is the PMR raising its head. Which you don't want - if it gets out of its cage you have a flare.

    • Guest
      Guest EileenH

      Posted

      Dear Eileen. thanks yet again.
    • track
      track Anhaga

      Posted

      Anhaga, I am sure it was you who gave me information on having a MRI, well all went well, and I get the results tomorrow.  It was certainly a Rock and Roll ride, the table was shaking at one stage, they gave me a blind fold if I wanted to use it, but I managed without. The Head phones came in handy with the music of my choice playing.  So all over with, also getting results for Holter Monitor and Echocardiogram tomorrow so will let you and Eileen know results. 

      Thank you for your in-put.

      Track  (hope I am onto the correct person)

    • Anhaga
      Anhaga track

      Posted

      I'm afraid it wasn't me.  But I do remember reading someone's description of their MRI experience - they said to cover your eyes with a cloth so you wouldn't get the claustrophobia heebeejeebies.  Glad you got through your experience all right.

    • EileenH
      EileenH Anhaga

      Posted

      I've had a head MRI - apart from being loud I didn't find it a problem.  I just closed my eyes before it started...

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