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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified MD
Category: Medical
Satisfied Customers: 63757
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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If polymyalgia rheumatica is caused by inflammation why are

Customer Question

If polymyalgia rheumatica is caused by inflammation why are my ESR and CRP blood tests normal even though symptoms return on reducing the steroids. I have the condition for 1 year now reduced to 3 mg prednisolone test results normal but symptoms increased so much rheumatologist increased dose to 5 mg for 2 months symptoms did not improve much blood tests again normal so decreased to 4mg for 1 month. Blood tests still normal but symptoms back and so now moved up to 10 mg. This is my history for past 4 months. When diagnosed first started out on 15 mg February 1 2013. March reduced to 12.5 mg April reduced to 10 mg and then each month reduced 1mg until I reached 3 mg as being guided by normal ESR and CRP results. Thanking you in anticipation of your answer.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Basu replied 2 years ago.

Dr. D.J. :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Dr. D.J. :

Hi there,


This is Dr. D.J., experienced Internal Medicine Specialist.


I am here to address your concerns and provide great service.

Dr. D.J. :

Indeed this is a very good question.

Dr. D.J. :

The ESR and CRP values should elevated with flare ups of polymyalgia rheumatica.

Dr. D.J. :

This is the usual case.

Dr. D.J. :

But in some cases, we do not see the expected rise in se rate and CRP even though patient may be symptomatic.

Dr. D.J. :

THis is likely due to the continue steroid use which blunts the rise in sed rate or crp.

Dr. D.J. :

Hence, although your symptoms are back due to the lower steroid dose, the blood tests may not reflect that.

Dr. D.J. :

Also, when you have been on steroid dose for some time, the body gets used to the steroid dosage.

Dr. D.J. :

Hence, lowering the dose may not be well tolerated in some cases.

Dr. D.J. :

If you are not experiencing any significant side effects from prednisolone, then the dose can be increased to 6-7 mg daily for 2-3 weeks before attempting to taper.

Dr. D.J. :

In case, you do not tolerate higher prednisolone dose, there is another medication called methotrexate.

Dr. D.J. :

Methotrexate can be used in place of prednisolone with lesser side effects.

Dr. D.J. :

Also, tapering of prednisolone may b easier while being on methotrexate.

Dr. D.J. :

You can discuss this option with your rheumatologist.

Dr. D.J. :

Best wishes,

Dr. D.J. :

I have given due respect and consideration to your concerns.


I have given the opinion based on scientific evidences and vast experiences.


Please respond with further queries if you need further information.


Please do not rate if you are not willing to authorize payment otherwise.

JACUSTOMER-ww4nqr4d- :

Thank you but this does not provide me with helpful additional information to what I already know.

Dr. D.J. :

what additional information you are looking for--please be precise

Dr. D.J. :

Please respond with further queries if you need further information.


Please do not rate if you are not willing to authorize payment otherwise.


I did not say anything wrong so far and do not deserve 'poor service '

JACUSTOMER-ww4nqr4d- :

If ESR and CRP are normal why symptoms which are caused by inflammatiion. Also I stated that I have been increased to 10 mg and you suggest moving up to 6 to 7 mg??? Continuing for 2-3 weeks. I have never tapered within 4 weeks up to now!!

Dr. D.J. :

prednisolone suppresses the body's ability to produce sed rate and crp.

Dr. D.J. :

This results in lower values.

Dr. D.J. :

But that does not mean yo do not have flare ups.

Dr. D.J. :

Another possibility can be you do not have polymyalgia.

Dr. D.J. :

You may have fibromyalgia in which case sed rate and crp will remain normal.

Dr. D.J. :

another possibility is steroid dependence--your body gets used to the certain dose of steroid and then it may want more--this results in symptoms even though you are on higher dose of prednisolone now.

Dr. D.J. :

I will suggest to reconsider the diagnosis if you are not responding well to 10 mg daily dose.

JACUSTOMER-ww4nqr4d- :

Not fibromyalgia no sensitive pressure points. Also had quick positive reaction to steroid treatment and symptoms disappeared fpr quite a while. Yes understand steroids reduce the inflammation but do not feel getting to the bottom of the question how symptoms return if inflammation is within normal parameters as perceived by CRP and ESR markers. At this point I will not give a rating as I do not want to authorise payment

Dr. D.J. :

Best wishes,

Expert:  Dr. Thomas, MD replied 2 years ago.
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