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Can sed rate and c reactive results be normal while taking Prednisone?
My rheumatologist is questioning whether I have PMR or something else because after 3 months on 20 mg of Prednisone both my sed rate and c reactive results are normal. He tapered me from 15 mg to 5 mg in 20 days (I was crying in pain) testing every 5 days, but my sed rate and c reactive results showed normal in every test. Could I have something other than PMR? My whole body hurts, but as the day progresses my legs feel like they have elephantitis (but they're not swollen). The Dr has run tons of other tests, we can't figure this out. I'm 75 and really fit, still trying to work out regularly. I don't like Prednisone!
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Sorry to hear about your plight. Difficult situation. The short answer to your question is that about 5% of people have normal ESR and CRP at diagnosis, and in many people the ESR and CRP return to normal during treatment. There is no specific test that proves the diagnosis. Tests are done to check for the possibility of alternative diagnoses. That being said, if one has typical symptoms, rapid relief (usually within hours) with low to moderate dose prednisone or prednisolone (approximately 15 to 25 mg once a day, best taken early in the AM), then the diagnosis of PMR is highly probable. Tapering off the prednisone is usually recommended to be slowly accomplished over about 12 months or so, and flaring of symptoms during this process is common.
So, in the context of your situation, if the diagnosis of PMR is correct, then tapering of the prednisone as rapidly as was done in your case would be expected to result in rapid recurrence of symptoms.
Did the initial treatment with 20 mg of prednisone relieve your symptoms?
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1 ReactionPMR is like a one-headed fire breathing dragon that needs to be tamed. Prednisone is a great medication to put out the flame of the PMR dragon. The inflammation that PMR causes is generally not detectable when we take prednisone but the dragon doesn't go away quietly. It grows another head while we take prednisone. You could label the second head of the dragon "adrenal insufficiency'' which might be more vicious that the first head of the dragon.
When we think the dragon is in remission we lower our defenses and reduce our prednisone dose. This gives the dragon a chance to revive itself with two heads. We wind up with PMR and adrenal insufficiency. The two-headed dragon is worse than the one-headed dragon and much harder to overcome.
https://www.everydayhealth.com/rheumatic-conditions/tapering-off-steroids-when-you-have-polymyalgia-rheumatica/
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Part of the difficulty of overcoming adrenal insufficiency plus PMR is because our body is already suppressed from overcoming PMR the first time. Prednisone replaces much of the cortisol in our bodies and leaves us defenseless unless we take more prednisone for a longer time.
Sed rate and CRP can be in normal range when on prednisone.
Rapid taper can result in painful flare up. The ESR and CRP don’t always correlate with our symptoms,
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@mark2471 yes, when I was at 20 mg of Prednisone I was great!