From the Guidelines
Elevated Erythrocyte Sedimentation Rate (ESR) is primarily caused by conditions involving inflammation, infection, or tissue damage, as seen in various studies 1. The ESR can be elevated due to numerous conditions, including inflammatory disorders such as rheumatoid arthritis, polymyalgia rheumatica, and systemic lupus erythematosus. Infections like tuberculosis, endocarditis, and osteomyelitis frequently raise ESR levels. Malignancies, particularly multiple myeloma, lymphoma, and metastatic cancers, are significant causes of elevated ESR. Tissue damage from myocardial infarction, surgery, or trauma can temporarily increase ESR. Certain physiological states like pregnancy and aging naturally elevate ESR. Specific medications including oral contraceptives, dextran, methyldopa, and vitamin A can also raise ESR values.
Some key points to consider:
- Inflammatory disorders are a common cause of elevated ESR, as seen in giant cell arteritis and Takayasu arteritis 1.
- Infections such as osteomyelitis can also cause elevated ESR, and markedly elevated serum inflammatory markers are suggestive of osteomyelitis in suspected cases 1.
- Malignancies, particularly multiple myeloma, lymphoma, and metastatic cancers, are significant causes of elevated ESR 1.
- Certain physiological states like pregnancy and aging naturally elevate ESR.
- Specific medications including oral contraceptives, dextran, methyldopa, and vitamin A can also raise ESR values.
It is essential to note that ESR is a non-specific marker that indicates the presence of an inflammatory process but doesn't identify its cause, requiring correlation with clinical findings and other diagnostic tests for proper interpretation, as highlighted in a recent study 1.
From the Research
Causes of Raised Erythrocyte Sedimentation Rate (ESR)
- Infection is a common cause of raised ESR, with studies showing that it is the most common disease association with extreme ESR elevations 2, 3
- Autoimmune diseases, such as rheumatoid arthritis and spondyloarthritis, are also significant causes of raised ESR 4, 2
- Malignancies are another common cause of raised ESR, with studies showing that they comprise a significant proportion of cases with extreme ESR elevations 2, 3
- Renal diseases and other causes, such as vasculitis and adult-onset Still disease, can also lead to raised ESR 4, 3
- Demographic characteristics, such as age and sex, do not appear to be strongly associated with raised ESR, although some studies have found higher ESRs in men than in women 2
- Laboratory parameters, such as serum albumin levels, platelet count, and ferritin levels, can be useful in discriminating between different causes of raised ESR 4, 3
Clinical Characteristics of Raised ESR
- Patients with raised ESR often have significant underlying medical conditions, with infectious diseases and malignancies being the most common causes 3
- The in-hospital mortality rate for patients with raised ESR is significant, with studies showing that it can be as high as 3.6% 3
- The overall mortality rate for patients with raised ESR can be even higher, with studies showing that it can be as high as 64.4% 3
- Patients who die from raised ESR tend to have higher mean age, ferritin levels, and comorbidities such as diabetes mellitus, heart failure, and malignancy 3
Diagnostic Accuracy of ESR
- ESR has a similar diagnostic accuracy to C-reactive protein (CRP) in the assessment of inflammation, especially in orthopedic conditions 5
- The combined use of ESR and CRP can yield higher diagnostic accuracy than either test alone 5
- However, ESR and CRP can have discordant results, and proper utilization of these tests requires consideration of clinical history and physical exam 6