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ESR and CRP and Immugabulin

Posted , 3 users are following.

pat38625
pat38625

Hi,  I was just diagnosed on 12th November with PMR and got started on 20mg pred.  Am just so happy to enjoy the absence of pain.  Had to get my bloods done this morning so got the opportunity to ask the nurse what my ESR was the last 2 blood tests.  First one was 124 on the 7th November and then it went down to 118 on the 17th November.  Also my CRP was 46.7 on 17th November, the nurse informed me my ESR should be below 10 but didn't say what my CRP should be, only that it should be lower.  Also testing my (I cannot spell this) immugabulin.  What does  immugabulin show and what is the normal rate.  I would be grateful for anybodies comments.  Thank you

0 likes, 22 replies

22 Replies

  • EileenH
    EileenH pat38625

    Posted

    I assume you are the "usual sort of age for PMR" - if so it is very unlikely you will ever get to an ESR of 10. But you may - mine is 4 but it was always 4, however ill I was! I imagine your CRP is done in the units where below 10 is normal. Mine has never been high either.

    I wonder why they are checking your immunoglobulin level - never come across it for PMR before. It is an antibody, a protein that identifies foreign bodies like bacteria and viruses and then destroys them, so important in your immune response to infections. At one time (1970s or so) it was thought that viruses might be the cause of PMR but that has been pretty much discredited now. If they are low then you will struggle to fight off infections, maybe they want to know as pred also supposedly reduces the efficiency of your immune system. Can't say I have noticed at the moderate doses used for PMR - I've had fewer colds in the last 5 years! There are 5 main immunoglobulins and they are low or high depending on the circumstances - what you have been exposed to so although I'm quoting figures they aren't particularly useful in that sense. Allergies raise some, infections raise others. 

    The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

    The results listed below are normal values for adults. Children have different values than adults. Results are usually ready in several days.

    Immunoglobulins

    IgA: 60–400 milligrams per deciliter (mg/dL) or 600–4,000milligrams per liter (mg/L)

    IgG: 700–1,500 mg/dL or 7.0–15.0 grams per liter (g/L)

    IgM: 60–300 mg/dL or 600–3,000 mg/L

    IgD: 0–14 mg/dL or 0–140 mg/L

    IgE: 3–423 international units per milliliter (IU/mL) or 3–423 kilo-international units per liter (kIU/L)

    Do let us know how you get on! So pleased you are feeling better with the pred though - but don't let them persuade you to reduce too fast. PMR and pred is a long haul flight I'm afraid, definitely not weeks, a couple of years is more usual.

    • linda17563
      linda17563 EileenH

      Posted

      Hello again, I`m glad Pat asked about readings.  As you know I have had some horrible syptoms in last few days....the surgery have now told me the results have come through for blood tests....only for the receptionist to say the doctor says have an appointment for Wednesday, and keep things as they are....will discuss readings then!   As you know the doctor last week said take 15 mg, welll no improvement, so upped it to 20mg myself....no change still....so here we go again, what to do next....and it`s interesting that you say readings can be "normal" and still get symptoms....so we have to rely on correct diagnosis from the doctor.....oh dear....
    • pat38625
      pat38625 EileenH

      Posted

      Thank you so much Eileen, I really do appreciate yourself and others like you on this forum.  I also google as well although I much prefer here because it has the human touch and I would rather pay heed to people here who have been there and got many t-shirts I have no intention of getting my preds reduced and will fight tooth and nail to get it reduced slowly but surely.  I will not be rushed. Thanks again and Thank God for people like yourselve and others.
    • EileenH
      EileenH linda17563

      Posted

      I think if the headache was due to GCA you would have had some improvement with 20mg though probably not a dramatic one. It does sound as if it is something else - after all, having PMR doesn't mean you don't get other things. It definitely sounds as if your GCA-related bloods were "normal" or he would have been telling you to come down to the surgery to get a prescription but possibly he has found other things that can be discussed at leisure and a plan of action made. 

      Has the headache improved at all? Anything else?

    • EileenH
      EileenH pat38625

      Posted

      I only googled that to get the figures - it's a long time since I worked in the lab and even then I'd have got the book out to check normal ranges! After 5 years of PMR though there are quite few I do have on memory file! And my computer is very well trained when I'm looking for stuff - it knows I don't want the woo sites! Trouble is, if I want to look up woo it is a problem 
    • pat38625
      pat38625 linda17563

      Posted

      Hi Linda, I understand what you are saying.  I have said to my gp and dr in hospital that one size fits all.  How can a jumper/t-shirt fit a person who is size 8 and a person who is size 28.  I know from my experience in the past 10 years (Not PMR) that when bloods come back normal then most drs will rely on this and other drs will do further investigations.  I am just so grateful for the people on this forum.  Hope you get sorted Linda.
    • pat38625
      pat38625 EileenH

      Posted

      Thanks anyway Eileen, I appreciate haveing knowledge even guidelines.
    • EileenH
      EileenH pat38625

      Posted

      I know at least one rheumy who has said quite categorically that he never looks at the bloods - clinical symptoms are king. I'd travel from one of the UK to the other to see him! Apart from anything else he's as crazy as me! lol
    • pat38625
      pat38625 EileenH

      Posted

      Well Eileen I fit into the crazy gang lol, have always done, it's just who I am.  I just appreciate when drs or people go that extra mile to dig deeper and think out of the box, it really does make a difference, but sure they are as rare as hens teeth.  I put a formal complaint into the hospital where I was seen by a Professor who never lifted his eyes once to me, just read through notes, dictated into his recorder and sent me to see the dietician.  I am more than a hospital number on a conveyer belt of patients.  I did get an apology and made sure that I would not be seeing him again.  So its back to endocrinology for me (don't know why) and not a reumy, but sure it's early days. 
    • EileenH
      EileenH pat38625

      Posted

      Where do you live (sorry if you have already said)?
    • EileenH
      EileenH pat38625

      Posted

      Hmmm - makes it a bit more difficult doesn't it. 

      OK - yes, you did say and I should have noticed the "sure its early days" shouldn't I? Can I put it down to pred brain? 

    • pat38625
      pat38625 EileenH

      Posted

      Of course you can.  I am still trying to figure out things as "is this a result of PMR or is it the steroids".   When I started on pred I was like the duracell bunny, I could not stop talking to my sons, when they were here.  It was like PMT I was aware I was doing it but for some reason I couldn't stop.  
    • pat38625
      pat38625 EileenH

      Posted

      Even though the preds are working, I have lost muscle power/strength in my upper right arm and still some residue of discomfort in my right thigth muscle.  Just getting a shower and using my right arm to wash is a murder picture and using my right foot on the accelerator in the car.  It is my dominant side.  So is this part of PMR or is it Pred, I think it's PMR though.  Still learning and am willing to learn so I will be able to make decisions along with my gp or hospital.
    • EileenH
      EileenH pat38625

      Posted

      I'm not sure it is due to the PMR - it might be of course but typically PMR problems are bilateral, possibly not equally bad but present on both sides. Also, if it were the PMR it should have improved not deteriorated. The concept of loss of strength due to pred is one that applies over a much longer period than just a few weeks.

      On another thread I have written quite a lot about myofascial pain syndrome and the similarities to PMR. I was told by someone who does research in it that it is commonly found alongside PMR. I have had both for a long time and the PMR can be reasonable but the MPS was hellish and made the PMR worse - does that make sense? Once the MPS was sorted out I have been able to reduce the pred dose steadily. The higher doses of pred can mask some of the MPS pain too but it can also get bad enough to break through even at the top end of the doses used in PMR.

      Google it and the Mayo and Cleveland clinic pages are good as is the video from spine health. What do you think?

    • linda17563
      linda17563 EileenH

      Posted

      The blurred vision/headache/shouder aches comes on worse a couple of hours before my pred is due......(makes me feel like a drug addict!)  I dropped to 15mg last night again, so will discuss this with my lovely lady doctor tomorrow, and hope we can come to some agreement on what it is, and a solution! (I had FBC done in blood test as well) sorry I don`t reply quickly, but it hurts my eyes to look at any screen (fibro) so do it in short bursts.....

      when you said Eilleen that you saw another Rheumy, can we request to see a dofferent one if we want to??.....

      Good luck to Pat as well....what a battle we all have....but we must keep positive...although very hard on some days......and of course xmas is coming!!

    • EileenH
      EileenH linda17563

      Posted

      Yes, you can always ask to see a different doctor if there is one in the hospital you are attending although sometimes it can cause friction if they get the impression you are being critical. In a small hospital there may only be one consultant which is then a problem. However, you can ask your GP to refer you elsewhere though sometimes that means a long wait because you go to the beginning again. However, if there is a question of GCA then there are some hospitals who operate a fast track system so the patient is seen in a few days maximum. I know that Southend, Bristol and Leeds offer fast-track and a few other places the rheumy will see a patient very quickly if they are phoned by the GP. The NE, for example, tried keeping spaces for both clinics and biopsies for a conventional fast track set-up but the demand was simply not there, but they will see patients for an opinion for/against GCA. In Dundee they have seen such patients as emergencies for years - even taking a letter and phone call from an optician as enough reason to see the patient in hours. In England it seems the optician writes to the GP and the GP may or may not take any notice. So that is worth considering with your lovely GP. But if you can't read comfortably and the pain remains there you need to see someone urgently I would say. All illnesses can present atypically and a positive response to pred, even if not complete, would suggest inflammation of some sort.
    • pat38625
      pat38625 EileenH

      Posted

      I will read the Mayo and Cleveland clinic pages later on.  MPR oh dear I do not envy you.  August/September this year, I cannot remember because everything is a blur but I would suffer from neuralgia but now I am wondering  was it really neuralgia?  I had terrible pains to one side of my head, really bad and my gp wanted me to go to A & E twice, but I new I couldn't sit and wait for 5 or 6 hours I just felt so ill.  I was taking pregablin but it didn't help. I had the pain for about 4 or 6 weeks but I had to go down to my gp every week just for me to get checked out re: headache.  My hair was sore to touch but again I had put this down to neuralgia which I would get from time to time.  I would like to know more about MPS so will do a wee bit of research.  You do make sense and I understand what you are saying.  Thanks
    • pat38625
      pat38625 linda17563

      Posted

      Thanks Linda I do hope you get sorted out with your gp.  I am understanding more and more thanks to this website and people like yourself.
    • pat38625
      pat38625 EileenH

      Posted

      Oh I forgot to say that I could not open my jaws wide because of the pain, which leads me to believe it was not neuralgia but thankfully it's gone, and I had it along with PMR (which I didn't know I had).
    • EileenH
      EileenH pat38625

      Posted

      You do know that mostly if you go to A&E and are too ill to sit waiting it does usually put you a bit further up the queue? Our local one here is very good except in peak skiing time when it is heaving but if you arrive to triage and are ill and obviously not well enough to sit and wait they put you on a trolley at least. And arriving with a doctor's note makes a difference too - it means you have gone through the "chain of command" and are not using A&E for a broken nail! Those symptoms do sound suggestive of GCA, especially the pain touching your hair. I had that for a few weeks as well as jaw pain but it went away on its own - very unusual I gather.
    • beatrice74480
      beatrice74480 pat38625

      Posted

      Hi Pat I too had jaw pain like neuralgia for about 5 weeks was worried about GCA but thankfully it has disappeared at the moment and all seems back to normal, I did have sinus prob tho so hopefully that was it,I have PMR for abour 20months and am down to 2/3 tablets daily a bit achy with this weather but mostly in hands, my last PMR was 12 but I have been 10 also, I thank Eileen for her wealth of knowledge on here, Good Luck
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