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I’m weary of getting ESR/CRP/Platelets in the appropriate age group, with no symptoms of GCA other than pain on all ocular motor palsies, and maybe I’m not alone. Typical scenario is a complete 3rd for example, ESR or CRP is elevated above age-adjusted norms, no symptoms of GCA, they ride the roller coaster of management of diabetes when placed on steroids pending the biopsy, and the biopsy is negative.

To put it bluntly, am I doing something wrong? Is there some fudge factor I should be applying to demand a higher ESR or CRP to trigger a biopsy in the typical diabetic patient already at substantial likelihood of it being a diabetic mononeuropathy? I haven’t yet found my own horror story of what should be a diabetic mononeuropathy being found to have GCA, but I’m sure there are stories.

Mitch

Original Message:
Sent: 1/5/2026 2:51:00 PM
From: Mitchell Gossman
Subject: ESR in a diabetic

I’m weary of getting ESR/CRP/Platelets in the appropriate age group, with no symptoms of GCA other than pain on all ocular motor palsies, and maybe I’m not alone. Typical scenario is a complete 3rd for example, ESR or CRP is elevated above age-adjusted norms, no symptoms of GCA, they ride the roller coaster of management of diabetes when placed on steroids pending the biopsy, and the biopsy is negative.

To put it bluntly, am I doing something wrong? Is there some fudge factor I should be applying to demand a higher ESR or CRP to trigger a biopsy in the typical diabetic patient already at substantial likelihood of it being a diabetic mononeuropathy? I haven’t yet found my own horror story of what should be a diabetic mononeuropathy being found to have GCA, but I’m sure there are stories.

Mitch

I sure do, and it always delivers a percentage that’s uncomfortably high in the mononeuropathy setting. Diabetics get GCA too, that’s the concern of course. But still… my experience has been that if you give, for ESR for example, a buffer of 10 mm/hr extra it would eliminate a lot of those biopsies.

Interestingly, if you enter all normal fields in the calculator, and it delivers a significant percentage risk of GCA! I doubt it reflects the actual risk of the average 80 year old on the street and is an anomaly of the calculations.

Mitch


Original Message:
Sent: 1/5/2026 3:07:00 PM
From: Andrew Carey
Subject: RE: ESR in a diabetic

Have you used Edsel Ing's GCA risk calculator based on 1400 biopsies from multiple institutions? It adjusts the risk for ESR and CRP as continuous variables rather than a certification cutoff. You don't have to move to a low yield biopsy in minimally elevated ESR or CRP regardless of DM or not.

Best, 

Drew

Original Message:
Sent: 1/5/2026 2:51:00 PM
From: Mitchell Gossman
Subject: ESR in a diabetic

I’m weary of getting ESR/CRP/Platelets in the appropriate age group, with no symptoms of GCA other than pain on all ocular motor palsies, and maybe I’m not alone. Typical scenario is a complete 3rd for example, ESR or CRP is elevated above age-adjusted norms, no symptoms of GCA, they ride the roller coaster of management of diabetes when placed on steroids pending the biopsy, and the biopsy is negative.

To put it bluntly, am I doing something wrong? Is there some fudge factor I should be applying to demand a higher ESR or CRP to trigger a biopsy in the typical diabetic patient already at substantial likelihood of it being a diabetic mononeuropathy? I haven’t yet found my own horror story of what should be a diabetic mononeuropathy being found to have GCA, but I’m sure there are stories.

Mitch