Anyone else have elevated CRP?
 

Out of all my tests, that is the only one that came back abnormal. The upper range was 4.9 and mine came in at 5. Could this indicate my PN is inflammatory and not autoimmune?

All of my lab reference ranges show CRP normal values as between 1-10...so 5 would still be normal for you.

I checked online at several places like Medscape and labtestsonline.com and they say the same...1-10.

Are you sure they are not listing your values for the hs-CRP (high sensitivity CRP) which is to measure the 'risk' of cardiovascular disease?

That's strange. It just says C reactive protein and it got flagged as high. Range is 0-4.9. Maybe it varies by lab?

Labs do vary...that's for sure. Still, such a very minimal elevation out of range (on their scale).

Did you have a SED rate done? If so, did that come back high?

Tunaboy, I had a chat to one of my clinical immunologist colleagues about this.

Her comment was that it is common for CRP measurements to vary between labs. She also commented that retesting of the same person in the same lab is often variable, assuming that there are no underlying changes in infection or inflammation.

Her very general opinion was that probably you have nothing to be stressed about :).

I just looked back at my test that was run last fall. It showed a reference range of 0.00 to 0.50. My result was <0.03

If my PN was inflammatory, it would probably be a lot higher. Too bad I have no other test results to prove it's autoimmune :(

What about SED rate? It's another test for inflammation.

Tests for inflammation are not always perfect, so you can still have inflammation and blood tests not reflect it.

Have they ever tried steroids to see if your symptoms improve? If it is inflammatory based, the symptoms will usually improve with steroids. It's not the best course of action (due to long term side-effects), but it can help determine if it is inflammation.

My sed rate is low at 4.

I tried alka seltzer the other day and it seemed to have reduced the burning. Could have been a placebo.

My doc offered a course of prednisone but im scared to take it.

Actually this got me thinking earlier today, was that my symptoms started after oral surgery. I was given IV steroids (not sure what kind, I am waiting to hear back from my surgeon) during my surgery. My symptoms started approximately a week after.

Then I read the below threads:
http://www.drugs.com/forum/need-talk...thy-29885.html

http://www.drugs.com/answers/prednis...hy-653205.html

Could steroids cause PN?

I'm sure anything is possible, but it certainly would be rare. I would think the autoimmune process would be more likely in your case since most AI diseases are 'triggered' by either an infection, virus, illness and even trauma/surgery...anything that causes a major immune response. Oral surgery could definitely be a trigger.

I understand not wanting to go the steroid route (I regret my years of steroids and the now permanent damage to my body), but if the course he prescribed is short (5-10 days in a taper), then it might be worth it just to see if the your symptoms improve. If they do, then you would at least know which direction to look for the cause (things with inflammation). You don't have to continue the steroids after you see they help...at this point just focus on hunting down the source of the inflammation.

I agree with en bloc. A short course of steroids could provide useful info, and it would be very unlikely to cause any permanent problems.

If it is inflammatory, you could have a better idea of what's happening, and possibly other meds to try that aren't steroid related.

A response to AlkaSeltzer can suggest that you have soft tissue damage/inflammation. Any NSAID may also work. Arthritis can compress nerves, and by reducing the arthritis, the nerves may quiet down.

Do you have dental implants? You keep mentioning IV steroids for your dental work... that is typically not common.
Did you exercise while having the dental work done? People who have infections or viruses, may drive the organisms into the tissues with too much activity. It is best to rest well when ill.
This happened to a gym teacher of my son's in high school... he
worked out too much while ill and drove the virus into his pericardial sac and almost died. (he was in his early 40's)

But it is possible if you have implants, that your body is reacting to them as a foreign object. We have had posters who reacted to joint implants..knee and hip... in the past.

Hi Tunaboy,

I get numerous autoimmune manifestations, a diagnosed arthritic autoimmune prob, mild psoriasis, uveitis ( both autoimmune), now the most lovely addition of diagnosed SFN. All are highly active and debilitating sometimes at the moment and my crp and ESR keep coming back normal. I think it was already mentioned that bloods don't always have inflammation. I have all this active autoimmunity and bloods show nothing at all. Naproxen does however alleviate the rheumatic pain greatly. That's an anti inflammatory drug. You see how confusing it can be?
I went for a one off corticosteroid shot in the backside after asking for it. It didnt help the neuropathy pain. That doesnt mean the neuropathy is not autoimmune. I understand certain neuropathies will respond if there's inflammation there. If I were you, I would ask for s corticosteroid shot I really would. As others have said it may help you rule things in or out. I hhad no bad effects at all. No mood swings, hunchback or moonface! :-) I think you should really considerate it.

Yes
 

Before I was diagnosed with PN, my CRP was also flagged high at 5.4 MG/DL. (Under the reference ranges, it states <0.8).

It was a terrible experience. I had all of the classic debilitating symptoms and the first (non neuro) doctor I saw said blood work looks good, I look like the picture of health and to try to enjoy life more. I insisted something was terribly wrong, again explaining my symptoms and he laughed and told me to have a good day.

No dental implants. No I stayed away from the gym. From what i've researched, most metal reaction symptoms are mainly joint/muscle aches, fatigue, hives, etc. I don't think I have read about pn symptoms.

Anyway, thanks everyone. I am leaning towards giving the steroids a shot, but no longer than 2 weeks (including the taper). I'm just worried how functional i'll be. I hear one of the side effects is insomnia. I have an exam next month and need to start studying for it. Decisions decisions.

YES insomnia can be an issue. It helps to take the dose in the AM vs in the evening.

You think a month of prednisone will do permanent damage? Maybe start with 60mg and slowly taper. I see my neuro tomorrow.

Frankly, I don't think you would need a month to know whether or not it will help. Prednisone works quickly and you should know within a couple days if your symptoms will be improving.

Also, 60 mg is a hefty dose. How did the doctor write the script for this...60 mg for how many days before starting a taper??

I don't think a month will cause permanent damage, but again, I don't think you will need a month. Typically, you can take Prednisone (even a larger dose) for up to 5 days (some says 7 days) and stop without a taper. I used to get 1000 mg by IV for 3-5 days in a row and stop without a taper, no problem. It's when you exceed that 5-7 days that the body stops making it's normal production of cortisol and the if you stop cold turkey, your go through withdrawal syndrome because your adrenal can actually shut down or become sluggish and then your are trying to function without any (or less then optimal) cortisol in your system. And trust me, the withdrawal syndrome from steroids is NO picnic!!

So you should maybe talk to your neuro tomorrow and ask about the length of time (and dosing) to take for an appropriate trial. At this point, you may just want to see if it IS going to help...then you can look at a long term approach once you find out if it will help.

I'm only going off of my first neuro visit when I only had slight numbness and tingling in my leg. She prescribed me 60mg for 3 days, 40mg for 3 days, 20mg for 3 days, 10mg for 3 days, 5mg for 3 days. I figure now that my symptoms have worsened, I might need to be on it longer. But for now i'm gonna stay under 2 weeks and see what happens.

The taper she prescribed is appropriate and you will be able to tell if it will help you within this short time period.

As an MT, I have performed many CRPs and sed rates. Your CRP is normal and is a better measure than a sed rate. ESRs should just go away... there are too many factors that can affect the results. Old physicians... old ways

When I had my terrible toxic spider bite, many years ago upNorth on vacation, I did a pred taper that was similar. Only I started at 40mg (I thought 60 was too much), and I extended the taper to include 2.5mg after the 5mg for 3 days. That was the first steroid I used. The return of my arthritis pain after that taper was a shock and considerable.

Last summer I just took 10mg a day for 2 weeks and tapered off to 5 then 2.5 over the next two weeks. That worked very well. The shock of the taper was much less. This was for my back flare.

When you say too much, what kinds of symptoms? My doc just prescribed me 80mg for 3 days, then 60, 40, 20 for 2 days, 10 for 2 days. So 12 days total.

Not sure if I will follow orders and start with 80. Seems to be a really high dosage. And I don't understand why some people experience joint/muscle pain will on it since it's supposed to be anti-inflammatory.


BTW, did you guys split up your doses throughout the day or all at once?

It is best to take them all at once in the morning. This mimics the body's physiological secretion of cortisol.

I had a toxic spider bite... that had a possible infection. I didn't think taking so much with an infection was a good idea.

I had let it go for about a week... taken care of it well...but it hurt so much I had to soak it in the cold lake. Then a creeping geographic rash started moving down into my foot. This bite was on the outside ankle bone. The center of the bite started turning black. (this I found out is a necrotizing reaction to the venom.) My ankle hurt for a long time after that. In fact it is my touchy left ankle of the foot I had surgery on 50+ yrs ago...
It has never been quite the same since.

Doctors like to give big bolus doses of steroids... but I felt that it was my body, and I should have a say too. So I did it my way.

The doctor up there said these were common...his wife had one from the golf course! Mine showed up from sitting on the dock barefooted, watching shooting stars at night. I thought it was a mosquito bite at first...but the doctor said no...there were two punctures like a spider makes. He put me on Zithromax antibiotic, the Prednisone and strong dose of Atarax.

That trio did the trick.

Does Prednisone take a while to kick in? I popped 80mg this morning thinking all hell would break lose. I don't feel a thing.

A couple days...and you will know whether it will help. And it's not like all hell will break loose...the pain will just subside some if it's going to help.

Wow it actually made me feel worse so I quit after Day 3. The first day I noticed nothing. The 2nd day I noticed all my symptoms began to intensify. In fact that night it was the worst intensity since my symptoms began. Same on Day 3 so I decided that it wasn't helping and stopped. I don't think a 3 day course needs a taper.

I just don't see how an anti-inflammatory and immunosuppressant could cause an increase in symptoms. Now i'm really confused. Prednisone usually helps people with autoimmune conditions since it weakens the immune system. Could this be an indication that mine is not autoimmune?

You are correct that you did NOT need to taper after just 3 days.

This certainly is odd that you had increased symptoms. I can understand if it didn't help, but to make it worse is strange. It may be that you just don't tolerate the medication/steroid...as in a type of allergic reaction.

I'm not sure I would eliminate the possible Dx of possible autoimmune cause. It could certainly mean that it is not, but the strange reaction to this may just be the medication, not anything to do with the root cause.

That is really strange.. It could be that you have
An infection somewhere.

I felt like a million bucks on the steroid..
At the end of that short taper I was back
In pain all over (arthritis pain).

That is odd. whenever I increase my steroids, I feel awesome (since it is short term), because it makes all of my aches and pains go away (nothing to do with neuropathy).

Maybe Mrs. D is right, and it allowed an existing infection to take the upper hand.

Were you really anxious about taking the steroids? Could the flare have been from possible stress/anxiety? I hope you don't take offense to that-I just have noticed that for me, personally, if I am anxious about something, my neuropathy will flare pretty badly.

High dose steroids would wear off into the evening and night.
Cortisol is after all a fluctuating hormone with highs and lows in 12 hr cycles, with the lowest at 4am or so.

High dose steroids also raise blood sugars, and when those drop, it would be a big LOW blood sugar and give symptoms of that.
This could be a problem for those with impaired glucose utilization to begin with. It is something to consider.

I didn't have any of those issues, however.

Good point Mrs. D.

I highest steroid dose I was on was when I went to into Addisonian crisis for a stomach bug about 4 years ago. I had to get IV steroids put into my body until the bug started to pass in the hospital-but they played it safer rather than sorry, and gave me way too much (not that I don't appreciate the safer than sorry tactic-it is definitely preferable to me getting LESS steroids than I need during an infection like that)-it caused me to bloat, and my blood sugar went up considerably. It went back to normal as soon as I was down to my normal dose, though. Perhaps a blood sugar swing aggravated things.

What infections could last this long? My only thought would be Lyme but i've already tested negative. Cytomegalovirus?

No I wasn't really anxious. Maybe a little bit the first day, but that day I felt fine. It wasn't until the second day towards the evening it started.

You can have an infectious arthritis simmering, a sinus infection, a chronic prostatitis, even a simmering endocarditis. Many of these may come from infected teeth, tooth extractions, any staph intrusion. Some people have simmering viruses in the liver, but liver blood tests would show those. Simmering Herpes simplex and Herpes zoster, and Parvo virus. My son had a mono infection (he just felt terrible and tired), for weeks before I sent him to our doctor...(when he came home from college one year) and when she did his blood work his liver enzymes were sky high. He had to wait months for his wisdom tooth extractions because of it.

Do you have any weakness with your neuropathy? I ask because steroids can exacerbate symptoms in multifocal motor neuropathy (MMN). I wonder if it is possible to exacerbate other types of neuropathy as well...in rare cases. There are many drugs that cause opposite of target effect in some patients. I wouldn't rule out that this is the way you react to steroids...at least high dose steroids.

Have you considered trying a lower dose to see if the same thing happens? 80 mg, is a really hefty dose...much higher then most tapers!! You might cut in half and try 40mg.

I agree with Enbloc - a short course of steroids could be the best way for you to clarify whether your neuropathic pain is part of the inflammatory process. This is nagging away at you and I can't see that a short course would do much harm although I avoid them like the plague as they make me go bio polar.

To shock you a little about the CRP. Mine is usually in the low teens while my ESR is usually quite high - between 30 and 60. Over the last five weeks my CRP has risen up to 160 twice and gone down in between to as low as 6.7! The huge surges have corresponded with symptoms that have led to two week long hospital stays and were assumed to be because of infection the first time but second time - this time last week I was re-admitted - two hospital consultants, one a nephrologist the other general - found no sign of infection. My ESR has been steadily rising and is now at 78. Conclusion - this a reflection of out of control inflammation as part of the autoimmune disease process.

I am not taking steroids yet and not on NSAIDs because of stomach issues. Nothing is simple or straightforward in my world but if I had your issues I'd take steroids and use them to play detective. :cool:

I have read that intermittent fasting lowers crp. I've been doing it for about 4 weeks and feel pretty good. The first week is hard. I do the 16/8 method.

I don't have any noticeable weakness. When I had oral surgery, I was given IV dexamethasone which is another corticosteroid. My symptoms began a week later. Could it be a rare allergic reaction to steroids? It seems my body does not tolerate them well. At this point I don't think a lower dose will do me any good. I just hope this eventually resolves over time.

If you had a reaction last time you received steroids in a different form & route, then YES, I would say an odd allergic reaction is possible. And it sounds like the results was even similar... you experienced the initial onset the first time, and increased symptoms of same the next time. Very strange. I wonder if this is the root cause to your symptoms.