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Vitamin D level - ESR - CRP what's the norm?

Posted , 11 users are following.

pat38625
pat38625

Hi, just got diagnosed PMR 12th November past (undiagnosed for 6 months). 

I was put on 20mg pred.  Was sent to Endocrinology 8th January where they have referred me to Rheumatology (no appointment yet).  Endo consultant told me to drom to 15mg.  I was seeing my gp the next day so confirmed with her that I was reducing to 17.5 which I am still on.  

Got blood results from Monday ESR 20  CRP 6.6  Vit D 72.  Receptionist rang me give me results and said ESR was still high and CRP is still high and Vit D is still low.  I thought ESR was ok for my age (just turned 60) I also though ESR was good under 10 but was told it should be under 5.  Dr. said keep taking calcium.  Thanks in advance for any replies.

2 likes, 32 replies

32 Replies

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  • tina-uk_cwall
    tina-uk_cwall pat38625

    Posted

    Hello pat, welcome to the club that no one wants to be in. I can't help you with all the technical stuff but tapering slowly is the best way forward.i started on 15 for 6 weeks, 12.5 for 6 weeks, then 10 for 6 months, then 9 for 6 weeks, unfortunately I had a flare when reducing to 8. So went up to 10 again to cover the flare up. From now on I'll taper down .5 all the way and stay on each dose for 6 weeks minimum. Presently I'm on 9.5.   If your vit d is still quite low, see if you can get a prescription for a higher dose of vit d. Calcium is excellent as prednisone is bad for the bones. I also take magnesium. Half magnesium to calcium. The aim is to stay on a dose that covers the inflammation and only when your ESR and CRP levels are back to normal should you think of tapering. Mind you having said that, I'm wondering if you should be reducing at all because if your ESR and CRP levels are slightly high that's an indication that there's still inflamation that's not under control. See what other members suggest before reducing further. All best wishes, christina
    • pat38625
      pat38625 tina-uk_cwall

      Posted

      Hi Christina, thanks for your reply.  It's just I get so confused by what is normal for my age.  I am not going to reduce as yet.  I may have to increase because I am getting dental implants.  Treatment may start in 2 weeks time.  I will be seeing the Implantologist on Monday and he is aware of me having PMR and pred.
  • MrsO-UK_Surrey
    MrsO-UK_Surrey pat38625

    Posted

    Pat - Normal ESR is considered to be 0-20 for women and 0-15 for men.  Normal CRP is anything between 0 and 4.9.  The ESR 'normal' can be slightly more elevated in the elderly.

    So your ESR and CRP results are really not bad.  You're quite right in believing that ESR in fact, can be slightly more elevated as we age.  If your results have improved since commencement of steroids, then reducing to 15mg should still allow those results a chance to improve further.

    Normal Vit D is considered anywhere between 75 and 150/200, depending on which health authority you come under.  You are just slightly low - perhaps your GP will consider giving you a 3 month course of high dose Vit D3 to improve it.  But a reading of 72 is really not bad considering we are in the middle of winter and not able to get a boost from the sun.

    • pat38625
      pat38625 MrsO-UK_Surrey

      Posted

      Mrs O thank you so much.  I think my results are pretty ok.  Just before starting pred my ESR was 124 and CRP was 46.7 so am not really complaining as such and yes I am only a wee bit away from 75.  So all in all good.  I am taking Adcal-D3 1500mg/400 iu  twice a day.  
  • LisaCACO
    LisaCACO pat38625

    Posted

    hi, sorry to have you join our group. I'm a newbie too, just having been diagnosed this December with GCA only.

    your CRP is rather high- here in the US most wouldn't have you wouldn't reduce unless it were lower than that (under 5). my question would be whether you're still having symptoms of PMR. Not sure why everyone is in such a hurry to have us taper down, esp since it can be so painful for us and frankly quite risky. I get the risks of staying on the steroids, but there are risks tapering too quickly as well. I'm curious to read what the  long term members here have to say. good luck!

    • pat38625
      pat38625 LisaCACO

      Posted

      Thanks Lisa, I am so grateful for this group, the members are fantastic and have loads of information.  I wouldn't be as knowledgable as I am without the people in this forum.  I am not in a hurry to reduce pred, as I said I will propable have to up them for dental work.

      I have a few aches and pains in my large muscles, thighs and upper arms but can manage.  Thanks again

    • tina-uk_cwall
      tina-uk_cwall LisaCACO

      Posted

      Well lisa, that's an interesting argument. Although I do not consider myself a long term member, as I'm still reducing inline with recommended treatment plans, but this question of taper, taper, taper at all costs because if you don't you will suffer from all the side effects of steriods is often debated on this forum. 

      This is my take on it. I don't want PMR, I don't want to be on long term medication, but I've got it so there it is. Prior to my diagnosis I was so incapacitated and in so much pain that I really believed that I was dying and even as a practicing Cristian there were days when I was so afraid for my future that I thought that death was preferable to the life I had lived for the past 3 months. When I was diagnosed and I took my first dose of prednisone and within 4 hours I was walking unaided up and down stairs, Turing my head left to right, which I had not been able to do for 2 or so months, most of the pain had vanished and I cried and thanked God for being alive. If prednisone hadn't been invented many of us I do believe would not be here today. Simply because, the inflammation that we suffer from that causes the pain must in its own way cause an enormous amount of internal damage, artery damage etc. GCA suffers would not just be blind but I'm sure would have suffered additional damage to the veins and arteries around the head area. So what is our alternative? Prednisolone. Yes it comes with new and unwanted side effects but many of the new and unwanted side effects can be regulated by other medication, what more medication? Well yes, but we must remember these conditions Whether it be PMR or GCA Are a. Pain in the neck, literally, it is not terminal and most of us will get better when the conditions burn themselves out and for the unfortunate sufferers whereby the conditions never burn themselves out they normally remain on a very very low maintenance dosage of prednisone for ever so the side effect risk is very minimal for them. I have suffered a flare when attempting to reduce from 9 to 8 and had to revert back to 10. I've now started my first reduction since that flare and I'm tappering so slowly, doing each taper in .5 reductions and staying on each dose, unless there's a reason to remain on the dose longer for a good 5 to 6 weeks. So yes I agree what's with the rush to taper us down quickly? There endth the lesson all the best, christina 

    • pat38625
      pat38625 tina-uk_cwall

      Posted

      Hi Christina, I could not go back to that type of pain.  I couldn't get in to bed or out of bed or into the shower or out of the shower, couldn't turn in bed.  Putting undergarments on a nightmare.  No one to help.  So I would rather take pred.  Also I think I had undiagnosed GCA, had the headache, one side of my head, couldn't touch my hair, my jaws were sore when opening.  My dr and I were going down the route of ME which I have had for 14 years and neuralgia which I would have from time to time.  Twice she wanted me to go to A&E but I felt too ill.  Pred has saved me, I don't know where I would be without it, do I want PMR (no) do I want to take steroids (no).  Tough I have it, I have accepted it and life is a lot better.  
    • tina-uk_cwall
      tina-uk_cwall pat38625

      Posted

      I couldn't agree more. It's a balancing act. We have to weigh up what our lives were like untreated and what they're like now, and as you say my life is a whole lot better, not the same as before PMR but a whole lot better. All the best, christina 
    • pat38625
      pat38625 tina-uk_cwall

      Posted

      Hear hear.  We just have to roll with the punches and be grateful that we are breathing.  All the best to yourself as well.
    • ptolemy
      ptolemy LisaCACO

      Posted

      My gosh my CRP has never been below 5 in the year I have had PMR. It started at 123 and my ESR 127. No one has ever said in UK I should be below 5 for CRP to start reducing. In fact my rheumatologist got me reducing when CRP was 31 and ESR 97. 
    • pat38625
      pat38625 ptolemy

      Posted

      Hi, the nurse who took my bloods told me CRP should be below 10, drs receptionist told me it should be below 5.  I haven't mentioned reducing as it was a consultant in endocrinology wanted me to reduce from 20mg to 15mg but I consulted with my own gp and reduced to 17.5 since 10th January.  I have been referred to a Rheumie but have no appointment as of yet.  I live in Northern Ireland.
    • ptolemy
      ptolemy pat38625

      Posted

      I was told the normal CRP range was 0-5 but that made no difference regarding the mad dash to reduce as far as the medics are concerned! 

      I think you are very sensible going to 17.5 first. My rheumatologist told me to reduce from 20 to 15 and it was a total disaster. The result being that I have taken much longer than I should have done in reducing and gone through a lot of unnecessary pain. The trouble was I was very naive in listening to doctors, I thought they knew what they were doing!

    • Sheilamac_Fife
      Sheilamac_Fife tina-uk_cwall

      Posted

      So well put, Christina! Totally agree. If there was something better than steroids we would take it, but this is what we have and I personally thank God for it!  I don't really wish it on anyone but I do often think that these dr's need to experience it so that can understand!
    • twigjean
      twigjean LisaCACO

      Posted

      Hi Lisa,

      The normals for CRP are different in the USA. CRP normals our methodology dependent. So if you're wondering what your normal is look up CRP or ESR on Google. Remember to put which countries normals you are looking for, hope this helps. Barb

      Sed rate normals are the same because methodology is most likely the same.

    • twigjean
      twigjean

      Posted

      p.s. These tests are nonspecific inflammatory markers. So anti-inflammatory causing mechanism can increase both the CRP and ESR

       

    • twigjean
      twigjean

      Posted

      sorry     -    any inflammatory causing mechanism.
    • ptolemy
      ptolemy twigjean

      Posted

      I thought CRP is measured in mg per litre/liter in the US and also the UK.
    • Sheilamac_Fife
      Sheilamac_Fife MrsO-UK_Surrey

      Posted

      Done! Thanks for the tip. Typing these replies here is often quite a struggle... Hope we can get some improvements.
    • twigjean
      twigjean ptolemy

      Posted

      Laboratory tests normals are methodology depend. In the USA CRP's are reported in milligrams/dL and in the UK milligrams/L hence the demical point difference. 

          CRP  0 - 1 mg/dL USA

                   1 - 10 mg/L UK

         Again methodology depend so there will a slight difference, meaning what manufacture the instrument the CRP was done on.

        ERS or Erthrocyte Sedimination Rate (same test)     this test is probably done by the same methodology the world over.          Men  0 - 22 mm

                Women 0 - 29 mm

       Vitamin D (My hospital's lab)

               

              30 - 100 nanograms/dL

      Here in the States labs are either private or hospital. At hospital labs I can look up my own lab work. Before retirement, I was a medical technologist. When getting lab reports from the doctor, if you are going to compare results between the USA and the UK, you need to to be aware the difference between us. I cannot speak to other countries methodologies used and other in laboratories.

      Hope this helps with the confusion.

    • twigjean
      twigjean

      Posted

      Siri and I sometimes have communication errors
    • EileenH
      EileenH twigjean

      Posted

      I hadn't read your post when I replied! Great minds and all that!

      The other thing that is confusing of course is just quoting numbers - blood glucose and cholesterol being two VERY confusing set-ups where you get millimoles and mg/dl where there is no connection between the numbers! The US and Italy use mg/dl - the UK millimoles. I can never remember the normal ranges of either and have to look them up!

      Your vit D levels are still a couple of years behind the UK who, all of a sudden, have decided that they were accepting far too low levels as OK as people were appearing with rickets and other bone disorders! 

    • twigjean
      twigjean LisaCACO

      Posted

      Thank you good article. For you UK people, NIH is the National Institute of Heath here in the USA
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