C-reactive protein, CRP

[Binkie4]

I knew my CRP had occasionally been logged as abnormal then returned to within range.
I just reviewed my levels in my GP record and noted that before 2014, the normal reference range was logged at below 10. Then it changed to below 5 where I sat until 2019 when I had an anaphylaxis. Since then it has been between 5-10, once or twice below 5. GP has never suggested investigating the rise. I have gained weight in those years. They coincide with when I had to stop doing exercise.

 

[Eleanor]

Just got some routine blood test results so I've added my vote (for 1-2).

Previous tests 3 months into Long Covid: CRP was 2, eosinophils high, plasma viscosity high, everything else tested was within normal ranges.
Recent tests 3 years into Long Covid: CRP is 1, eosinophils still high, plasma viscosity not tested, everything else as before.

 

[Steppinup]

We've discussed CRP on a number of threads. There are some hints of mildly raised CRP in ME/CFS and some suggestion that levels may track with fluctuations of illness severity. But, there are a lot of confounding factors. I'm going to link some of the papers and discussions here.

When completing the poll try to choose a range that reflects most of your CRP levels, rather than your highest ever level. If there is an odd one that you know was related to a specific infection unrelated to ME/CFS, ignore it.

Thank you @Hutan, @Jonathan Edwards, @Woolie and others for all the interesting CRP info, it's always something I have wondered about. I voted 10-20. It fluctuates from normal ie <6 up to 19mg/L except of course the 2 times I had septicaemia and then it was up to 87. All with normal BMI (20-22)

I also frequently have corresponding mild normocytic normochromic anemia, low haemoglobin, mild to moderate thrombocytosis and mildly elevated white cell counts as well as low sodium and osmolality.

Iron is mostly normal but transferrin saturation low despite good dietary intake.

In the early years while I while still able to work and drive ESR also was elevated and CRP back then was sometime 30 or 40s, ERP is mostly in normal range now. ANA and thyroid occasionally tested and always normal.

My impairment level course is similar to @DigitalDrifter and @Evergreen in that it relapses for months/year at a time and remit for much fewer months but not usually back to previous baseline and I have generally deteriorated over time so now mostly bedbound/housebound depending on whether in relapse or not. Bad NMH from the start and POTS/SFN added last 10years

 

[Joni]

My CRP was tested 3-4 times in 2018 when I had health insurance. I was significantly overweight.

CRP was 7- 9 mg/L
ANA positive 1:40
elevated ESR 32 - 40 mm/H
elevated IgA
and elevated Glucose 6-PD (20.2 U/g Hb). *

*apparently this is uncommon to have elevated, but I wonder if my beta thalassemia minor contributes?

Rheumatologist put undifferentiated connective tissue disease on my chart.

No follow up in 8 years. Maybe one day if I can ever get decent health insurance, I can follow up.

I rarely hear of anyone with ME who also has something like rheumatoid arthritis (an occupational therapist I was seeing for finger and wrist pain suggested RA to me). I wonder if it's rare to have both.

 

[Concentric_Spiral]

My CRP was tested 3-4 times in 2018 when I had health insurance. I was significantly overweight.

CRP was 7- 9 mg/L
ANA positive 1:40
elevated ESR 32 - 40 mm/H
elevated IgA
and elevated Glucose 6-PD (20.2 U/g Hb). *

*apparently this is uncommon to have elevated, but I wonder if my beta thalassemia minor contributes?

Rheumatologist put undifferentiated connective tissue disease on my chart.

No follow up in 8 years. Maybe one day if I can ever get decent health insurance, I can follow up.

I rarely hear of anyone with ME who also has something like rheumatoid arthritis (an occupational therapist I was seeing for finger and wrist pain suggested RA to me). I wonder if it's rare to have both.

If you learn more about the coincidence of ME and ADs I would love to know - I was diagnosed with eosionophilic fasciitis roughly 6.5 years into having ME/CFS.

 

[InitialConditions]

I was diagnosed with eosionophilic fasciitis roughly 6.5 years into having ME/CFS.

Can I ask what symptoms this gives you and whether you have objective signs of this, e.g on the skin?

 

[Evergreen]

My CRP is nearly always <1mg/L.

I checked two sets of bloods when I know I had infections - it was normal for the viral infection that triggered ME/CFS, and elevated to 26 at the beginning of a bacterial infection.

 

[Concentric_Spiral]

Can I ask what symptoms this gives you and whether you have objective signs of this, e.g on the skin?

From my elbows to my fingertips, and knees to toes, the fascia thickened a lot. Fingers curled, couldn't form fists, feet 'froze' so I have near zero ROM. The skin all tightened a lot, and my shins look 'shiny'. Elbows had contractures too. Also got weird rash patches in random places, some silvery/shiny. Couldn't walk more than a few blocks before pain becomes prohibitive - changed very recently only.

Three years later, a lot of the restrictions have loosened, which is apparently common for EF. As of a few days ago only, I seem to be able to walk more. Could be as a result of 20 infrared and near-infrared laser treatments I got from a naturopath, or could be natural remission.

 

[MrMagoo]

The CRP level if you have something like pneumonia is over 100, so having a “slightly elevated” level at 10 really is just that, slightly elevated.

 

[Arnie Pye]

The CRP level if you have something like pneumonia is over 100, so having a “slightly elevated” level at 10 really is just that, slightly elevated.

Another point of comparison...

I saw it mentioned on a TV program some years ago that a patient had a CRP of 50 with a chest infection.

Something I find irritating... When I get some copies of blood test results I don't actually know how high or low something has to be before a doctor will pay any attention to any results.

For example, if I had an over the range potassium level it might cause a doctor to be slightly concerned. If I had an over the range vitamin B12 level I can't imagine it would make any doctors bat an eyelid.

 

[Felis Catus]

All my test results from the past few years are "<4mg/L". I didn't know you could get a more precise low value, at least in the UK.

 

[AliceLily]

The CRP level if you have something like pneumonia is over 100, so having a “slightly elevated” level at 10 really is just that, slightly elevated.

I think I had pneumonia in 2015. I never got a clear diagnosis. It took a year before my voice got back to normal and the added exhaustion left. I must have a look at my notes and see if they measured my CRP.

 

[MrMagoo]

I think in the UK the blood tests now show on a kind of bar chart, on the NHS app, but still you don’t know whether a few extra points is tiny or huge. You just know it’s outside of “normal”.

My CRP always being around 7 isn’t remarkable.

 

[AliceLily]

Another point of comparison...

I saw it mentioned on a TV program some years ago that a patient had a CRP of 50 with a chest infection.

Something I find irritating... When I get some copies of blood test results I don't actually know how high or low something has to be before a doctor will pay any attention to any results.

For example, if I had an over the range potassium level it might cause a doctor to be slightly concerned. If I had an over the range vitamin B12 level I can't imagine it would make any doctors bat an eyelid.

My potassium level was abnormal last check. There were some other things too like white blood count. Doctor never got back to me, I must make a GP appt today and get bloods taken again.

 

[Xenodica]

Mine has consistently been around 25 mg/L for the past 6 years or so. I've had it checked every year (sometimes more than once per year) during that time and it's always around that. My ESR is also usually in the 40 mm/hr range. No source for this inflammation has been found, and I have to wonder if whatever it stems from is what is causing my ME.

 

[Jonathan Edwards]

The sample is not that big but it provides quite a good confirmation that CRP levels are normalin people with ME/CFS. I would regard the spread on the results as very normal.

CRP of 25 mg/L does not necessarily indicate inflammation. Nor does ESR of 40. They are used as 'markers' of suspected inflammation but lots of other factors affect their levels and they are not in themselves 'inflammation'. (Having said that, an ESR of 40 deserves some other basic investigation, but probably not a CRP of 25mg/L.)

 

[Xenodica]

The sample is not that big but it provides quite a good confirmation that CRP levels are normalin people with ME/CFS. I would regard the spread on the results as very normal.

CRP of 25 mg/L does not necessarily indicate inflammation. Nor does ESR of 40. They are used as 'markers' of suspected inflammation but lots of other factors affect their levels and they are not in themselves 'inflammation'. (Having said that, an ESR of 40 deserves some other basic investigation, but probably not a CRP of 25mg/L.)

What would consistently elevated CRP and ESR tend to indicate, then? And any ideas on investigations for the ESR?

Given the POTS and ME/CFS alongside these elevated inflammatory markers, would that not raise suspicion that they're involved? There's out of range blood test results and physical symptoms, granted they're not necessarily related, but wouldn't the suspicion be that they might be?

Thanks for responding.

 

[Jonathan Edwards]

Given the POTS and ME/CFS alongside these elevated inflammatory markers, would that not raise suspicion that they're involved?

As far as we know from past data ME/CFS and POTS are not associated with inflammation, or with raised ESR or CRP, so if these indicate anything it is likely to be something else, either incidental or something else causing symptoms misintepreted as ME/CFS.

ESR reflects a rise in a range of globulin proteins like antibodies and fibrinogen. There are lots of diseases where antibodies change and the ESR goes up but there is no inflammation. CRP is more specifically something that rises in an individual with inflammation. But the problem with CRP is that individuals' normal levels very hugely. So 25mg/L may be normal for some people and 2mg/L for others..

 

[Xenodica]

But the problem with CRP is that individuals' normal levels very hugely. So 25mg/L may be normal for some people and 2mg/L for others..

Ah, that's really good to know! For some reason I was stuck on the idea that 25 mg/L couldn't be a normal concentration, that there simply isn't that kind of variance in the population. I wonder if that calls into question the validity of hsCRP as a marker of cardiovascular disease risk? Or is it more to do with the change in CRP from an individual's baseline, rather than an absolute number?

Ok. So the ESR is indicating antibodies/fibrinogen, etc. at a higher concentration than is considered typical. I'll look into this more to satisfy my curiosity.

Thanks for your time!

 

[Jonathan Edwards]

I wonder if that calls into question the validity of hsCRP as a marker of cardiovascular disease risk?

I think that remains a robust epidemiological finding. But the variation in individual baseline CRP, which is genetically determined, may have something to do with it I guess. I don't think anyone knows why the risk status is linked to CRP. People hand wave about inflammation all the time these days but that doesn't pin anything down.

Ok. So the ESR is indicating antibodies/fibrinogen, etc. at a higher concentration than is considered typical. I'll look into this more to satisfy my curiosity.

The classic example is myeloma where the ESR is 100+ because of the antibody clone but there needn't be any inflammation. A more subtle situation is lupus where the ESR may rise alongside inflammation but can also be high because of abnormal antibody populations.