PMR, Prednisone
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C-Reactive Protein. My C-Reactive Protein was 67 when I was diagnosed about 17 months ago...normal C-Reactive Protein is under 10 (in the USA). It has gone down...is now at 16. Does this mean my cardiovascular risk is still extremely high because of the inflammation?....or is C-Reactive viewed differently if you have PMR?
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burt34192 kathy67492
Posted
Depending on the lab where your blood is tested, a normal CRP is in the 1-3 range, and from 3-7 it gives evidence of cardiovascular inflammation. Above 7, the CRP shows only a non-specific type of muscular inflammation, like PMR. The CRP is not a disease specific test, nor is the ESR (erythrocyte sedimentation rate), so the clinical symptoms of where you hurt, stiffness, and age, to name a few, are as important in making a diagnosis of PMR.
kathy67492 burt34192
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tina-uk_cwall kathy67492
Posted
burt you say that CRP levels indicate levels if non specific inflamation in the body, which is precisely what I was lead to believe, yet you continue to say that CRP levels between 3-7 is evidence of cardiovascular inflamation? Therefore are you saying that raised CRP levels of between 3-7 is a certain indication of cardiovascular inflamation?
i am aware that PMR in some cases does affect the heart, but not in all cases, because if what you are saying is correct then why are we all not rutinely having our heart function tested as part of our recovery plan if our CRP levels were between 3-7?
both of you have me worried now!!! Regards, tina
EileenH tina-uk_cwall
Posted
Patients who have GCA are known to be at an increased risk of cardiovascular disease at a later stage - but that isn't necessarily the heart alone. The main areas of inflammation are in blood vessels, arteries. They tend to give rise to symptoms if they are involved - claudication when walking, possibly Reynauds syndrome and so on. They are the sort of thing you would go to your GP about anyway. It is recommended that GCA patients should be monitored for aortic aneurysm every 2 or 3 years. Abdominal aortic aneurysm can be easily seen using ultrasound and a nationwide screening programme is available for all men over 65 - because that is the group most likely to develop one. Anyone with a family history or who is at risk for various reasons (like GCA) can request to be added to the screening list - the U/S takes a few minutes and doesn't require any preparations. There is also a risk of thoracic (chest) aortic aneurysm - that is more difficult to see because of the ribs being in the way - and the recommendations are that a chest x-ray be done every couple of years. Sometimes it is, sometimes it isn't. Far better is an echocardiogram - where they see a 3-D image of the heart using ultrasound but it requires an expert to do it so isn't as generally available as the ultrasound to see your baby we are all so familiar with.
It isn't as easy to test cardiac function as you might think and it would have to be done regularly - and time and money constraints mean it isn't really an option as a screening tool. Some would involve repeated exposure to x-rays or other radiation - too much of that isn't good for you either. It is all a balance.
What is mos timportant is that you report any possible cardiac symptoms to your doctor and be persistant if the symptoms are persistent - I had palpitations but they were dismissed at first. They only happened occasionally but eventually it was found I had atrial fibrillation probably due to the autoimmune part of PMR - but a/f is actually very common amongst our age group anyway.
There is no point worrying about what might never happen - yes the rate is higher for certain things but most of them occur in the general population sooner or later whether thay had PMR or not!
EileenH kathy67492
Posted
"CRP is a protein that was first isolated from the plasma of patients with pneumococcal pneumonia in 1930. The protein was so named because it binds to the C-polysaccharide of the pneumococcus. It was later found that the protein appeared in plasma during many infectious or inflammatory conditions.CRP is synthesized in the liver. Its physiologic role is to bind to phosphocholine expressed on the surface of dead or dying (apoptosis) cells in order to activate the complement/immune system, which enhances phagocytosis by macrophages. Levels of CRP begin to rise within 2 hours of an insult, and has a half-life of about 18 hours. The rapid action of CRP makes it a participant in the acute or first phase of the inflammatory process, which is why it is often called an "acute-phase protein."
Rapid, marked increases in CRP occur with a wide variety of disorders including infection, trauma, tissue necrosis, malignancies, and autoimmune disorders. Since a large number of disparate conditions can increase CRP production, it cannot be used to diagnose a specific disease such as rheumatoid arthritis. CRP is merely an indicator or biomarker of a disease process that is causing cell death due to inflammation.
Today, a high-sensitivity CRP test, usually designated as hs-CRP, measures low levels of CRP using laser nephelometry. Several studies suggest that an elevated hs-CRP is predictive of coronary heart disease. Arterial damage results from white blood cell invasion and inflammation within the walls of coronary arteries. A high hs-CRP, therefore, is a rough proxy for cardiovascular risk. The widespread use and publicity surrounding the association of hs-CRP with heart disease may have obscured its diagnostic role in pain and other non-cardiac conditions. If a pain patient has an elevated hs-CRP, it simply means that there is an active focus of inflammation—be it in the heart, CNS, or elsewhere in the body—and efforts must be made to eliminate it."
and
"It is important to remember that both CRP and hs-CRP become elevated in a wide range of acute and chronic inflammatory conditions such as infections, rheumatic arthritis, many other inflammatory diseases, and many cancers. These conditions cause release of interleukin-6 and other cytokines that trigger the synthesis of CRP by the liver.
Because there are many disparate conditions that can increase CRP and hs-CRP, an elevated CRP level does not indicate a specific disease.
Due to its poor sensitivity and low negative predictive value, measurements of hsCRP can not be used to rule out disease.
Most clinical guidelines have emphasized that data from experimental research, epidemiological studies, and large clinical trials do not provide conclusive evidence for the routine use of hsCRP measurements for risk prediction.
At this time, there is insufficient evidence to recommend widespread use of hs-CRP in clinical practice."
As burt has said - a sustained very high CRP suggests that there is some major inflammation present. What the high specifity CRP suggests - only suggests - is there is some low grade chronic inflammation going on. Also somewhere - not necessarily in the cardiovascular system though it probably usually is of the patient is healthy. It is all associated with theories that long term low grade inflammation is the cause of certain diseases. It is probably associated with many things - but correlation is not always causation. hs-CRP is much much lower - CRP is measured down to about 3-5mg/l, hs-CRP is measured down to about 0.3mg/l - so well within the usual sorts of levels acceptable in a healthy individual.
The hs-CRP is of interest in otherwise healthy people who might be at risk of a heart attack at some later time - but even then, it may happen, it may not. But if there is a risk you can look at lifestyle changes to reduce that risk.
kathy67492 EileenH
Posted
but I understand the test now, and why it is just an indicator...not necessarily definitive. What is tour background, Eileeen, if you don't mind...it is invaluable to have your expertise on this forum!
EileenH kathy67492
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kathy67492 EileenH
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Appreciate your contribution to this forum!
EileenH kathy67492
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kathy67492 EileenH
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EileenH kathy67492
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