Before I go any further, I understand that CRP and ESR tests are not a reliable guide to PsA (have read heaps about that), and until today my tests have have always come in on the low side for both of these… despite pain (in many joints), visible swelling (albeit minor), some minor stiffness, and shocking fatigue… however, today I got the results for the blood tests I had yesterday and ESR has just topped over the ‘normal’ range (range is 0-15 and my test was 16)… so I looked back over past test results and have noticed an upward trend over the last 3 months in both CRP (has gone from 1 to 4) and ESR (has gone from 8 to 16).
Now, I’m not overly concerned about this, but it has raised a few questions for me:
Is this a common thing in PsA? (I suppose there are many other things that might do this do)
Might it be an indication that the Mtx isn’t working as well as it could?
Might this perhaps be an indication of the disease progressing more rapidly?
Hi janson. I’m one of those whose ESR / CRP does seem to rise and fall in line with how well-controlled the PsA is. Before diagnosis ESR was in the 70s, CRP topped at 45. Low dose steroids sent both right down close to zero, thereafter Mtx kept it around the range you’re currently showing. Since starting Humira in 2014 both have remained in single figures. After such a long time with negligible levels I would see small rises as indicative that the PsA was a wee bit more active.
However I’m aware that there are many other reasons for rising levels, many of them quite innocuous e.g. a low level infection of some sort. And also your current levels would be perfectly normal for many healthy people. I doubt your rheumy would consider the levels anything to worry about, I think it’s the trend over time that can form a piece of the jigsaw so if they keep on climbing then perhaps that will influence treatment.
I know many people with PsA don’t show indication of disease activity this way, but my levels have been tested monthly for the last 5 years or so and for me they are definitely part of the picture.
Thank you so much for your response Sybil, most appreciated!!! I do realise ESR and CRP are not specific and may alter in response to a wide range of things… but certainly feel like the PsA might be ramping up a little too (slowly)… I guess I’m kinda hoping that the increase in these might be enough to warrant a ramp up in meds a little too (and therefore maybe a little relief).
Have been trying to stay stoic through all of this and give Mtx plenty of time to be effective, but to be honest am feeling pretty fed up at the moment lol Just been having a rough few days I guess (I’ll get over it lol).
Wow 70’s and 45 seem off the scale compared to my usual negligible levels (I think 2.5 is the highest CRP I had on record until now, and have ESR only for the last 3 months… I must have a look through some older stuff but definitely the last 2 years have had very low results).
It could prove to be a good thing if these tests can be used as something to guide of PsA activity, in my case, not much else seems to work well for that
Thank you again!! I do hope things are keeping under control for you these days!!!
That’s how I see it too. My levels play ball, they just do seem to tally with whatever’s going on PsA wise, but clearly that’s not always the case. How much Mtx do you take at the moment? Looking back, the small rises in my inflammatory markers prompted slightly higher doses of Mtx I think.
Am currently on 20mg… and seem to cope OK with that SE’s-wise at the moment, although it doesn’t seem to be doing much to help pain etc (if it is helping I dread to think the state I’d be in without it lol)… also on daily tilcotil (NSAID, along the lines of celebrex I think)
I think I’m due a rheumy appt in about 6 weeks… will be interesting to see if he says anything about it.
I’m a big believer in repetition. One test represents a single point in time, and scientifically speaking if you are looking to make any sort of correlation, you really need more than one or two points. That being said getting blood tests done every week is obviously not very practical. It seems like it warrants further investigation, but I think ESR/CRP would be useful when paired with additional information to clue you in. Do you keep a diary to track your symptoms? Do your symptoms follow the same trend? Hopefully your rheumatologist has some insight.
Hi there Weasel, thanks for your input here, most appreciated!!
I understand what you are saying scientifically and understand how one point may well not be significant… perhaps I should have expanded my post a little… the test results I have from earlier this year (Jan and Mar) both came up with CRP at 1.0 (ESR was not tested at this time). I am currently on monthly testing (due to increasing Mtx) and tests have shown an upward trend over that time (CRP: Jun 1.5, July 2.3, Sept 4.0 - ESR was 8 in June and July and 16 in Sept), I was a couple of weeks late getting the 3rd test done, it should have been done in August. And yes, the increase does seem to correlate with a slow increase in joint symptoms too… I haven’t noticed symptoms of any other condition that might increase inflammatory markers, and all other bloods (CBC/kidney/liver) are OK, so it has me curious
I do keep a sort of diary of symptoms, but really only of anything new, appointments, meds, and sudden, notable flares in symptoms.
I do understand this may not be significant, especially as have had issues with ankles, feet, knees, hips, hands, wrists, elbows, shoulders and spine since at least March last year and no sign of increase in CRP (in May last year CRP was 2.5, ESR was not tested until June this year).
It will be interesting to see how future monthly tests pan out
Thank you again for your input!! I do hope things are picking up for you!!!
@janson, just to clarify that I’m not saying it’s not significant (I would never want to downplay anyone’s experience–I think I lot of us have been downplayed by doctors enough!). It certainly seems like it might be the way that you are describing it, especially if it’s associated with an increase in joint symptoms. I’m just not a big fan of relying entirely on test results to tell us what’s going on, since results for PsA seem to be pretty variable. I’d be sure to mention to the rheumy that your joint symptoms seem to be increasing too.
@Weasel, no need to clarify!!! , I completely understood where you were coming from, I too try to look at things from a scientific approach (although a somewhat uneducated one ), and find it difficult to formulate an opinion on most things without a wide range of data to work from (I guess one of the reasons I was asking for others opinions/experiences).
Oh… yes… it is soo common to have symptoms etc. downplayed by doctors, and others… and test results have never proven reliable for me… having had experience over the years with pets and the vets I learned sometime ago about how common false positive/negative test results are too… throw in a condition that regularly doesn’t show at all in bloods, even when it’s running rampant, and it seems tests cannot be relied on at all for a large number of people with PsA.
I have done a LOT of research in the last year or so, since my GP put the puzzle together and came up with PsA (which, in my opinion, if not quite correct is certainly very close to the mark), and at times get a little overwhelmed with the conflicting information/data that seems to be available… everyone’s experience with this is so unique, there seems to be no “norm” with it… at this stage I am still in that darn GAP between diagnosis and successful treatment and the frustration of it all has been getting to me a bit lately… so I guess I was hoping to hear if any others have had this experience with inflammatory markers and what it has meant for their PsA.
By my next rheumy appt. I will have had at least one more round of tests done… perhaps they will continue the current trend… perhaps the trend will reverse by then, only time will tell… grrr… more waiting… (oh dear, my impatient self is starting to rear it’s head)
@Weasel. Actually dead on in thinking. There was a massive study done at Mayo a few years back and the trend shown by ESR and CRP IS significant. However you need a minimum of 3 data points for a trend and this washed up old math teach prefers 16 (which gives you a 97% chance of being right) BUT those scores also vary widley and medications effect them as well (especially MTX) One of the more interesting things taht came out of this study is that only one of them was an accurate predictor. Incidentally the study was done not for diagnostic or interesting information (that they do nothing with) but rather to establish a data base to predict which type of biologic might be best.
ESR levels scare the hell out of me for some reason. Mine go up and down like a yo-y0, and I’m always worried that something has been missed and that PsA gets the blame for something else entirely!
I don’t know my CRP numbers, but when I first had PsA, my ESR numbers slowly rose to the 30s, and then at one point when, for a reason not worth going into now, I wasn’t on meds, it went up to 109. Hydroxychloroquine got it down to the 30s again for a while. By April of this year it was 60ish. Steroids this summer got it down to around 12 or 13, but two weeks ago it was at 83. That’s up 70 points in five or six weeks. At that point, though, my PsA was horrendous, and I had at least one skin infection, possibly two - which also will have made a difference.
but it’s my understanding that some people have severe PsA and yet have perfectly normal levels of ESR. The Doc didn’t seem too worried about the rise to 83 as it tied in with symptoms and the infection - and all other bloods were pretty much normal. And I am assuming it can’t be anything too drastic if sank like a stone with the steroids during the summer.
@tntlamb. Thank you soo much for chirping in here!!! I was hoping you would
Yep, I understand the more data points the more accurate the conclusions from that data… OK so which of the tests proved to be accurate in the study you mention? And when you say Mtx can affect them would you please expand on this a little for me, I’ve been on Mtx for nearly a year now but started out slowly (at my insistence), still in the process of increasing it, have been on 20mg for a few weeks now. I really am trying to understand what it all might mean, while I wait out the time to see where things might go from here.
I was always one of those horrible students who kept asking questions till I ‘got it’ lol
Until now I hadn’t bothered much with the test results (other than to know what they were) as they had both stayed well within normal range, so I had considered myself to be one of those that would probably stay that way. I kinda feel it would be a good thing if the tests prove to start playing along with symptoms, might help the docs, and myself, to realise I’m not just imaging it all (no, I don’t really believe that’s quite what they think ) , as I have little to show for it all at this stage. lol
I’m also one of those awful people who like to prepare for the worst, hope for the best, while accepting I’ll probably end up somewhere in the middle of that continuum.
The more I understand, the less I worry about things.
Thank you for sharing that @darinfan… Wow, numbers jumping around like that would take a bit to get used to… I can understand why it would scare you!! I know mine seem to be pathetically low in comparison, and also understand how some can have severe disease and still not have it show it the test… PsA really is a weird thing to deal with, must drive the rheumys and docs nuts at times I’m sure.
My other bloods all still seem to staying in the normal range too, so I’m not stressed by it, just very curious. Oh, by the way, my skin involvement is nigh on non-existent since being on the Mtx and was only ever very minor anyways.
Yes, tying it into the PsA has to help the docs with treatment decisions etc, or at least I would think so.
Janson, I think you’re right to ask questions of your docs. My questioning them probably drives them nuts, but its our bodies and I want to know what’s what, and why it is like it. There is nothing worse than knowing enough to scare you, but not enough to out your mind at rest again. It;s a bit like Dr Google. It tells you enough to give you the willies, but not enough info for you to understand it properly. So, for example, the doc telling me I’m aenemic is likely to get me worrying, but if he tells me I’m anemic because of X, Y or Z and that is “normal” is fine, and will keep me settled.
As for the idea of “normal” within blood tests, it seems to me the whole thing is nuts. I can’t remember what blood test it was, but normal was 0-60. I was 75, and I asked if that was anything to worry about, and was told "no, we don’t even worry about that at all until it’s about 150. So, why in heaven’s name is 0-60 normal then! I’m sure there is a method in the madness somewhere. But knowing only scraps of information does us no good.
I absolutely agree with you darinfan… the more information we have (as long as it is accurate and reliable information) the easier it is, for me at least, to put things in their proper place. I can cope with most things in life once I understand them
Sometimes it can be difficult to judge just how accurate and reliable the data is that can be gleaned from Dr Google… some of it is incredibly valuable, some a lot of codswallop lol I do try to only pay attention to sources that might be able to be considered reliable (I probably don’t always get that right though).
@darinfan Normal doesn’t mean “normal as in okay” with blood tests. normal refers “Norm” or specifically to the range that 68% of people taking the test fall into. It is nuts. It called the 68–95–99.7 rule.which is a shorthand used to remember the percentage of values that lie within a band around the mean in a normal distribution with a width of two, four and six standard deviations, respectively; more accurately, 68.27%, 95.45% and 99.73% of the values lie within one, two and three standard deviations of the mean, respectively.
@janson The increase in inflammatory markers with MTX (most specifically CRP) is interesting it occurs most frequently with folks the closer they get to 60 and is time dependent;
Even MORE interesting is the fact that it MOST often happens with PsA patients than any other arthritis patients. MTX is metabolized in the liver which is where CRP is produced. As long as those leveles don’t increase too much and start to come down, its a good thing. It means the body is responding. as over 50% of folks have normal levels and we treat the disease not the blood test its understandable that The liver gets concerned that something is wrong when something that effects one of the protiens it makes. so it goes to work to produce more CRP as that is how infection is fought. What the liver doesn’t know is that its supervisor (the immune system) is incompetent…
Interesting to me is that the 6 month efficacy ratings are almost an inverse match to the increased CRP rates. but all I have ever got is a chin rubbing “interesssssssting” when I’ve talked to primary researchers.
@janson. Whether ESR or CRP is the best indicator is wholly dependent on the patient. It will only be onebut rarely both. CRP measures a specific protein ESR measures the sedimentation of red blood cells over the period of an hour. It basically is checking the function of fibrinogen (that’s a way over simplification) both indicate inflammation CRP is far more sensitive but as each is a different process, the whole thing becomes pretty individualized.
I find this conversation interesting. Both on a personal and professional level. for me I have had an elevated CRP until my last set of Cortisone shots. It was the first time in over 5 years since I was diagnosed where I had an undetectable level of crp. In the last 3 months it has slowly started to creep up. Still within a normal range. I have not really felt the CRP was an overly good indicator of my disease progression. Other then it still showing I have inflammation. I was once told by my GP that my CRP of 13 was normal and not to worry. I run numbers CRP’s at work (lab tech) and I can guarantee most of the ones I run are Less then 1.
And as such you prolly understand the test more than others. I will go to the grave proclaiming that med students do NOT take near enough math and have become so dependent on a lab report that they can not use the incredible brains they have… A basic business student will look at a chart of CRP or ESR and say Uh oh sumpins happening.A statistican (or investment banker about the same thing) would go nuts if he looked at a chart (never mind the values) of most of our inflammatory markers and start issuing sell orders.
Thank you so very much for expanding on that @tntlamb… It’s too early in the morning here for me to process it all straight up… so will take some time to ponder lol
Ermm… that’s what you get from me this morning too
It’s good to know (unless if I have misunderstood) that it might simply be the Mtx that has increased the markers (I’m only a little short of 60 years lol), and that this might be an indication of the Mtx starting to take some real effect… to date improvements from it have been pretty minor, although I do wonder if the Mtx might be slowing the progression some, as in I might be a lot worse without it (something I guess we’ll never really know). The main benefit I have noticed from the Mtx to date is a reduction in fatigue levels… it’s still there but not nearly as bad as it was.
I will hang on to hope that I do prove to be one of those whose ESR/CRP levels prove, in time, to be useful indicators of progression… it must be frustrating for docs when they have no lab work to rely on.
I did find the results of CRP taken about 8 years ago that had come in at 8.5 (ESR wasn’t done at the time)… my GP thought the chest pain I was experiencing may have been costochondritis, frustrating that he ruled that out on the low CRP level. It is a shame that some docs seem to read the bloods as gospel. It seems maybe the PsA has been hanging around for years in a very mild form but 18 months ago decided to go a little nuts
What I can say is I will definitely be keeping a closer eye on these results for the next little while, a wee spreadsheet might be in order
Thank you once again!! Your input is invaluable!!!
I too find it interesting @dakotasun… thank you for your input!!
Of particular note for me is your mention of most of the CRP tests you run coming in at less than 1… hmm… perhaps there is more significance to any result over that than I originally thought.
It would seem to make sense that cortisone shots would bring these levels down and very quickly, given their purpose.
I understand what you are saying about inflammatory markers not being a good judge of progression… I really do need to pay more attention to my terminology… perhaps I should use the term “activity” rather than “progression” in this instance… pfff… sometimes I have terrible issues finding the best words to use, and grab the first one that pops into my fuddled brain, not always wise
Thanks again for your input here!! Most appreciated!!
), and find it difficult to formulate an opinion on most things without a wide range of data to work from (I guess one of the reasons I was asking for others opinions/experiences).
