Slow taper and elevated ESR a& CRP

Personally I never base my dose on anything other than how I feel.  The markers are useful to an extent, but why take more pred if you feel okay?  Markers can be raised for a number of reasons which may have nothing to do with PMR.  

 

I’m glad you enjoy the discussions. There’s some very helpful advice available. I’m also on the slow taper (DSNS) and have reached 9/8.5mg. My inflammatory markers have always been very sensitive to changes in my pred, and I can sense the readings just by how I feel. My rheumy looked at me recently and knew exactly what my markers would be, and he was spot on! At my current level of pred, I’m feeling just a little more symptomatic, and my CRP has crept up to 40, the highest it’s been since I started steroids. I’m going to persevere though as I’m pacing myself and know my limitations. Regarding an anti-inflammatory diet, not everyone finds it helpful. I had one of my best days after a day packed full of the so-called worst food I could have eaten. As they say though, if it works for you... Good luck!

I agree with Anhaga. My inflammatory markers can drop to normal and then the next time she checks it it'll be high. So one month of really having high inflammatory markers should not be something you use to determine how much prednisone you should be on. How are you feeling? Do you have a lot of pain? If not, then in my opinion you should stay with your schedule because it's working. I went for about 2 years with an elevated sed rate and had no particular pain and my doctor felt it was probably related to my bad back. Then when it skyrocketed and my CRP was high and I was symptomatic is when I got the diagnosis of PMR.

I've been on Pred since being diagnosed last July.  As soon as I started the prednisone, my pain was gone, and I haven't had any pain since then!  But my CRP and SED continued to be high.  The internist couldn't believe that I had no pain with such high levels.  But I just had another blood test, and the SED is normal, and CRP are just above.  And I still experience no pain.  I have no idea why those levels were as high as they were, and why they are down now.  I'm fluctuating between 5mg and 4.5 mg pred right now.

Have you had any other reason for the raised ESR/CRP? A chest infection for example? A single raised result shouldn't trigger a kneejerk raising of dose UNLESS you also have symptoms. Raised levels due to PMR are more likely to lag behind than precede symptoms and a whole range of things can cause high readings.So the blood test should be checked in a week or so - and if has continued to rise then you have to ask why. It may not be PMR - but it is a sign there may be something else besides PMR going on. There may not of course - but it has to be considered.

HOWEVER - if the dose is too low, even slightly too low, to manage the daily dose of inflammation some will be left over and it will mount up. Eventually it will be high enough to cause symptoms - which will be as bad as the start if you ignore it. You can TRY being strict with diet but there are no guarantees it will achieve as much as just 1mg more pred. Remember, the unmanaged inflammation also does damage to the body - and that the low doses of pred used in well-managed PMR do not cause any extra problems that wouldn't occur anyway in a population of a similar age not on pred.

https://www.practicalpainmanagement.com/resources/news-and-research/polymyalgia-rheumatica-steroid-side-effects-new-findings

Remember too, it doesn't mean you won't get lower. Just perhaps not yet. And that ignoring the reality of a flare could end up with you in a state that needs a much higher dose to get under control - and all that perceived benefit of "I got to a low dose" will be wiped out in a just a week or so.