From the Guidelines
Elevated sedimentation rate (ESR or sed rate) in osteoarthritis suggests the presence of another concurrent condition, as osteoarthritis itself does not typically cause significant systemic inflammation that would elevate inflammatory markers like ESR. While osteoarthritis is primarily a degenerative joint disease characterized by cartilage breakdown, as noted in the 2019 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee 1, it generally does not cause significant systemic inflammation. If a patient with osteoarthritis has an elevated sed rate, this finding warrants further evaluation to identify the underlying cause, which could include inflammatory arthritis, infections, malignancies, or other inflammatory conditions.
Some key points to consider in the evaluation of elevated ESR in osteoarthritis include:
- The need for additional blood tests such as C-reactive protein (CRP), complete blood count, rheumatoid factor, anti-CCP antibodies, or imaging studies to identify the underlying cause of the elevated ESR.
- The importance of reconsidering the diagnosis or looking for coexisting conditions that could be causing the elevated sed rate.
- The fact that osteoarthritis treatment focuses on pain management, physical therapy, and maintaining joint function, not on reducing inflammatory markers, as outlined in the management guidelines for osteoarthritis 1.
Given the information from the 2019 American College of Rheumatology guideline 1, it is clear that the presence of an elevated sed rate in a patient with osteoarthritis requires a thorough investigation into its cause, rather than attributing it to the osteoarthritis itself. The elevated sed rate itself does not require treatment; rather, the underlying condition causing the elevation should be addressed, with treatment strategies guided by the specific diagnosis and the patient's overall clinical presentation.
From the Research
Elevated Sed Rate in Osteoarthritis
- Elevated sed rate, also known as erythrocyte sedimentation rate (ESR), is a common finding in patients with osteoarthritis (OA) [ 2 ].
- Studies have shown that ESR is significantly higher in patients with knee OA compared to those without knee OA [ 2 ].
- ESR has been found to be related to clinical features such as tenderness, swelling, and patellar ballottement in patients with knee OA [ 2 ].
- The relationship between ESR and radiographic severity of OA has also been investigated, with higher ESR levels found in patients with more severe radiographic changes [ 2 ].
- Other studies have reported that a significant proportion of patients with OA have elevated ESR, with 21.2% of women and 8.5% of men having ESR > or = 30 mm/h [ 3 ].
- ESR has been found to be associated with body mass index in women with OA, but not in men with OA or those with rheumatoid arthritis [ 3 ].
- The clinical significance of elevated ESR in OA is not fully understood, but it may be related to the inflammatory response associated with the disease [ 4 ].