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Suggest Treatment For Elevated Inflammatory Markers

Posted on Mon, 16 Feb 2015

Question: I have a chronic elevated WBC (approx 15), ESR (30-50), and CRP (60). I am negative for all auto immune diseases and arthritis tests. This has been going on for 5 years no answer. I feel sluggish flu like symptoms often and pain in some joints, mostly hands. Saw a Rheumatologist, said it was Arthralgia. Still doesn't explIn my tests. Was told it was just something I had to live with. I take Mirapex for RLS, no other medications, female, age 40.

Answered by Dr. Naval Mendiratta (44 minutes later)

Brief Answer:
There is a possibility of Arthalgia.

Detailed Answer:
Good evening.

Thank you for writing on health care magic

Well I do see your inflammatory markers are high. Since all the autoimmune and arthritis work up are negative you don't need to be too worried about it. However I will ask you a few other questions to rule out some other disease which may have been missed, just to be sure. However since it has been 5 years it may look unlikely.

1. Do you experience any back pain or neck pain

2. Do you experience any abdominal pain or pain in the arms on activity

3. Has your blood pressure been different on both the arms measured

4. Any headache associated

Do let me know these queries. Would be happy to guide you further

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Naval Mendiratta (3 hours later)

I do have lower back pain quite often and I do have neck pain but was found to have a bone spur and disc narrowing at C6/7. My blood pressure was always the same on both arms, monitored often and still check both at least 2x a month now just to make sure I don't need to go back on meds. I do get frequent headaches and wake up with a headache. No pain while exercising.

Answered by Dr. Naval Mendiratta (12 hours later)

Brief Answer:
cause of raised inflammatory markers

Detailed Answer:
Good evening

Thanks for your reply

Could you shed more light on the backache and neck pain. Considering your age of 40, it is normally not expected.

1. Do you experience this pain. On walking more or at rest?

2. Do you experience difficulty in the nights while turning positions?

3. Is your pain worse in the mornings and is accompanied with stiffness?

There is a possibility that the raised markers are due to your back pain and neck pain. There is a condition called spondyloarthopathy which is associated with such symptoms but it normally doesn't affect the females in severity compared to males.

Since your blood pressures are OK in both arms we will rule out the possibility of any vessel disease.

Do let me know these queries

Would be happy to guide you

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Naval Mendiratta (2 days later)

Hello, my pain is more when at rest. Once I am up and moving around it does seem to help, but I stiffen up pretty quickly once seated. Yes, at night when I have to turn over (which I do often as my back is screaming) it does hurt me. When I get out of bed in the mornings it is worse, I have to walk a bit semi hunched over till I can fully straighten up. Again, it is a whole body stiffness but mostly in my back and joints in my hands. The pain is mostly in my lower back which I feel is near my tailbone. The neck pain is in my neck and mid back and shoots down my left arm, but again, that was determined to be a pinched nerve and bone spur in C5/C6, C6/C7. I do have mild narrowing in my lumbar discs as well.

Answered by Dr. Naval Mendiratta (9 hours later)

Brief Answer:
Spondyloarthopathy

Detailed Answer:
Good evening

Thanks for your reply

Well the sort of pain you are describing looks like an inflammatory back pain. The back pains we see in patients are mostly 2 types:

1. Mechanical- that is the pain which gets better on rest and aggravated on activity. you wont have difficulty in turning positions or experience early morning stiffness. The inflammatory markers are also normal in such state

2. Inflammatory- The sort of pain you have described here with raised inflammatory markers

You can discuss your rheumatologist about the possibility of Spondyarthopathy and get HLA B 27 checked. It is mostly a disease of the males, but females can have it too but in a milder form. It normally gives pain and stiffness in the females but in males it can cause full forward bending of the spine due to fusion. You can read it up on net also and see if your symptoms fit in and discuss it with the rheumatologist. That may very well be the cause of raised ESR and CRP.

Do read up and let me know for your queries

Would be happy to guide you further

PS: I am sure your response to pain killers or anti inflammatory will be good

Regards
Dr Naval

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Above answer was peer-reviewed by : Dr. Shanthi.E