Sed Rate still elevated, but pain much improved

Go to a shoulder ortho and see if you can get a steroid injection to address the local pain. That should help for weeks to months and help resolve this specific pain for awhile, this giving you time to address the question if you really have an active PMR case. Good luck - it takes some common sense and chasing of specific pains to get over the PMR hump. My theory is that PMR set off the inflammation in joints that didn't need help being inflamed and that oral steroids are never going to resolve these areas.

Thanks for your reply! Your idea sounds very reasonable, especially since I also have an arthritic knee which is causing a lot of pain intermittently, also stage 4. I didn’t even know I had OA before I had PMR. I have seen an ortho for the shoulders, and he says steroid injections would do little since the OA is so advanced. He strongly recommended shoulder replacement, which I am considering. I see him again soon for the knee, and am hoping the gel injections might be an option. I am leery of steroid injections since I already have osteopenia. I see my rheumatologist next week, and hope she approves continued tapering despite the elevated sed rate.

I have both PMR and severe osteoarthritis and have had 4 joints replaced and need the other two replaced. I have at times both pains and I take a 650 mg Tylenol Arthritis pill and if it helps it is osteoarthritis. If it does not help it is PMR. Another difference is that if it is PMR I have trouble standing, not just pain but physically my muscles won’t work. This has helped me to tell which pain I am dealing with. I have been on prednisone almost 4 years and my Sed rate has remained in the 80s. I tried three drugs to help me taper but had to quit them due to side effects. I am now down to 7 and a half mg of prednisone. I am having adrenal insufficiency blood work soon. I switched endocrinologists and my new one is SO much more thorough than the last one.

First, I would ask for a steroid shoulder injection now in an effort to settle down the pain and local inflammation while you are sorting out your problems. The steroid injection is a much more localized anti-inflammatory treatment. Do realize that even an injection will spread outside of the immediate area.

Shoulder replacement is serious surgery and takes time to recover, not to mention that any surgery is going to elevate your inflammatory markers temporarily. Surgery is invasive at a minimum. The quicker you get your inflammation down the better you will be.

I too have osteopenia and have had more injections than I care to admit over the last 5 years. Once I got the inflammation down I moved to different pain management treatments. For my greater trochanter bursitis, I get wet needling. For my OA in my knees I get hyaluronic acid (gel) injections. And for my shoulder OA I was getting steroid injections but am looking into private pay hyaluronic acid injections to avoid steroids and shoulder replacement. Right now I have full range of motion in my shoulder and until the range is significantly limited I do not plan to have the surgery. I have already had rotator cuff surgery on both shoulders. Long, tuff recoveries.

I cannot take any non-steroidal anti-inflammatory drugs either Rx NSAIDs or over the counter. I have learned to tolerate temporary pain and save steroids for the must have situations. My approach says there is a difference between getting the inflammation down and keeping the inflammation down.

Do you know you C Reactive Protein (CRP) number also? Your Sed Rate is often considered to be the trailing inflammatory marker. My Rheumy uses both, my Infectious Disease doctor really only uses CRP. CRP does seem to drop faster than Sed Rate based on my observations.

My CRP number has been normal most of the time, with one recent reading of 12. An increase in pred for one week brought it back down. My sed rate seems to be the one that is more important for me. It was 77 at time of diagnosis, stayed in normal range when pred dose was high, but with lower pred dose has been up and down. My rheumy thinks I might have some sort of inflammatory arthritis other than PMR (in addition), which is why I have started methotrexate. After three months it seems to be helping with PMR pain. She told me osteoarthritis is not a disease of inflammation and does not cause elevated inflammatory blood markers. I wonder if anyone on this forum knows more about that? As to a steroid injection, I used to have full-blown osteoporosis, probably caused by a lot of steroid over the years to treat asthma. I currently take an inhaled steroid (fluticasone/salmeterol), which MAY get into the system, as is true with steroid injections. I have tentatively agreed to total reverse shoulder replacement, which supposedly has a shorter and easier recovery time than the traditional surgery. The idea of PMR triggering OA pain makes a lot of sense to me. My PMR pain was bilateral, but my shoulder pain is much more on my right side. PMR pain was always worst in the morning, and my OA pain can be worse in the evening particularly if I have been more active. Sorry to be so long-winded. I really appreciate your replies.

Talk with your ortho - I believe your rheumy's knowledge is not totally current. These days doctors have wheelhouses and they stay there. There is very little cross wheelhouse knowledge. Each wheelhouse is hard enough to master. I would also suggest you talk with PCP about other possibilities.

I asked Micrisoft Bing AI what the causes of an elevated Sed Rate are and this was the answer. 4 of 5 answers are not in Rheumy's wheelhouse -
Inflammation
Autoimmune diseases (such as rheumatoid arthritis and lupus)
Infections (bacterial, viral, or fungal)
Cancer (lymphoma or multiple myeloma)
Chronic kidney disease

"Does anyone know if osteoarthritis can cause elevated inflammatory markers?"
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Anything in medical terminology that has the suffix -itis is associated with inflammation. Osteoarthritis is caused by inflammation due to mechanical wear and tear on the joints. It isn't chronic inflammation associated with autoimmune disorders but it is inflammation nevertheless.

How high ESR and CRP are elevated probably depends on many factors but PMR is NOT helpful if you already have osteoarthritis. I think PMR compounds the pain from osteoarthritis. Since PMR inflammation is in the area surrounding the joints and not inside the joint -- everything starts to hurt.

I think it is safe to say that osteoarthritis can cause elevated ESR and CRP levels but probably not chronically all the time. I also believe chronically elevated inflammation markers "aggravates" osteoarthritis.

"C-reactive protein (CRP) levels can be elevated in osteoarthritis (OA) patients. In addition to indicating systemic inflammation, it is suggested that CRP itself can play a role in OA development."

Hi Dadcue
My PMR Rhumo says “I only treat people, symptoms and not numbers” and that’s exactly what he does. And it works for me , keeps me well without unnecessary doses of damaging steroid medication.
My inflammatory markers fluctuate ( sometimes upwards) and don’t necessarily follow my much improved, almost non existent PMR symptoms.
I’d say you’re correct in thinking high inflammation markers can be caused by a lot of other underlying conditions besides PMR, and if high inflammation persists without increasing PMR symptoms it’s warranted to investigate other possible underlying causes /diagnoses as well , such as your osteoarthritis or many other illnesses / diseases that raise inflammation.

I had those conversations with my rheumatologist too. For the most part she always believed me when I told her how much pain I had. I wasn't one to complain too much about PMR pain. I took very high doses of prednisone intermittently to control painful flares inflammatory arthritis, uveitis and trigeminal neuralgia long before I was diagnosed with PMR. I actually said PMR was was a "blessing" to me. I was given a legitimate prescription for daily prednisone for as long as I needed it.

There was one time when I told my rheumatologist that 25 mg of Prednisone didn't seem like enough because of how much pain I felt. I suggested 30 mg but she looked at me in disbelief and said she better check my inflammation markers. After my inflammation markers were checked she said I should increase my dose to 35 mg.

My inflammation markers were always elevated no matter how much Prednisone I took. My rheumatologist would ask me if I was sure I was taking enough prednisone because my inflammation markers were always elevated. I would have to tell her that my pain was controlled in spite of my elevated inflammation markers. Eventually my inflammation markers were deemed to be "unreliable" and we went strictly by my symptoms.

When I started on Actemra (tocilizumab) my inflammation markers were very low. I had never seen my inflammation markers within the "normal range" before this time. I was concerned and asked if my inflammation markers were "too low." They were nearly zero and I wasn't sure if very low inflammation markers were normal.