Diurnal variation of ESR, CRP, and PMR symptoms
Posted , 12 users are following.
I am currently on 15 mg of pred which I take in two doses of 7.5 mg, one at 1 am and one with breakfast at approx 6:30 am. With a split dose I can keep my symptoms at a minimum, which I cannot do with one dose. After one month of pred a blood test taken at 9:30 am shows ESR of 14 and CRP of 8. That looks good, but I still have about 20% symptoms at night and in the early morning.
The blood test was taken around the time when the pred level in my blood would be at or near its peak, so the question is, what is the diurnal variation of ESR and CRP, and what time would be the ideal time to measure it?
This relates, of course, to the criteria for remission and thus for tapering. If you go by the symptoms alone, what would be the criteria for remission when you consider the 24-hour variation of symptoms? You might have close to zero symptoms in the middle of the day, but say up to 30% of the original symptoms at some time at night. Would that qualify as remission?
The PMR Activity Score appears pretty useless to me, as most items are hard to estimate with any degree of accuracy, and the CRP value may very well vary over a 24-hour period, so that it could be inaccurate as well.
I suspect that many of you have come up with your own criteria for a "successful" remission. If you would share them with us it could be very helpful in preventing too much trial and error.
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stevep63 carldk
Posted
I am a large active male in my mid 50's. I have worked out that I metabolize a minimal amount of the pred and am better for keeping moving generally, as long as I don't over do it for me. I don't really get pain. It's more stiffness and weakness for me. I don't really take much notice of my Gp or rheumatologist! I am working it out for myself and with the help of Eileen and others on the forum. The medical establishment seems way behind in latest studies and thinking on PMR! Their suggestions seem contradictory to what I experience and often do not make common sense. Also, they keep pushing for methotrexate as well, which I will not take. They have been useful with all the testing though, to rule out other things and keep an eye on different functions etc.