From the Guidelines
An elevated erythrocyte sedimentation rate (ESR) indicates the presence of inflammation in the body, but it is not specific to any particular condition, and its management should focus on identifying and treating the underlying cause rather than the ESR itself. This non-specific inflammatory marker measures how quickly red blood cells settle in a test tube over one hour, with faster settling suggesting increased inflammation 1. The ESR test has sensitivity estimates ranging from 0.54 to 0.78 and specificity ranging from 0.46 to 0.95, indicating its limited use as a standalone diagnostic tool 1.
Common Causes and Management
Common causes of an elevated ESR include:
- Infections
- Autoimmune disorders (like rheumatoid arthritis or lupus)
- Certain cancers
- Inflammatory bowel disease
- Temporal arteritis When evaluating an elevated ESR, clinicians typically order additional tests such as:
- Complete blood count
- C-reactive protein
- Specific tests based on the patient's symptoms Treatment depends entirely on the underlying condition, with options including:
- Antibiotics for infections
- Immunosuppressants for autoimmune conditions
- Other specific therapies as needed The ESR value itself may be monitored over time to assess treatment effectiveness, with decreasing values suggesting improvement in the inflammatory process.
Clinical Considerations
It's essential to understand that ESR is most useful when interpreted alongside clinical findings and other laboratory tests, as it provides information about inflammation but cannot pinpoint its specific cause 1. For patients with conditions like giant cell arteritis, an increase in ESR may indicate a relapse, but it should be considered in the context of clinical symptoms and other diagnostic findings 1.
Monitoring and Follow-Up
Monitoring of therapy for conditions associated with elevated ESR, such as large vessel vasculitis, should be clinical and supported by measurement of inflammatory markers, including ESR 1. Periodic imaging with MRI or positron emission tomography may also assist in assessing disease activity in conditions like Takayasu arteritis. However, the use of these imaging modalities needs formal validation for monitoring vasculitis activity.
From the Research
Erythrocyte Sedimentation Rate (ESR) or Sed Rate
- The erythrocyte sedimentation rate (ESR) is a marker of inflammatory conditions and has been used extensively by clinicians in both outpatient and inpatient settings 2.
- An elevated ESR indicates the presence of inflammation in the body, which can be caused by various conditions such as infections, autoimmune disorders, malignancies, and renal diseases 3.
Factors Influencing ESR
- ESR values can be influenced by demographic factors, lifestyle factors, and common metabolic abnormalities, including age, sex, body mass index, smoking, physical activity, and metabolic syndrome 4.
- ESR is higher in females than in males and increases steadily with age, with median ESR values being 2-fold higher in females and individuals aged >65 years compared to males and younger individuals, respectively 4.
Clinical Applications of ESR
- ESR is commonly used to assess the acute phase response and has important roles in the diagnosis and follow-up of rheumatoid arthritis, temporal arteritis, sickle cell disease, osteomyelitis, and noninflammatory conditions such as stroke, coronary artery disease, and prostate cancer 5.
- ESR can be used in conjunction with C-reactive protein (CRP) to enhance diagnostic accuracy, particularly in orthopedic infections and other inflammatory conditions 6.
Management of Elevated ESR
- The management of an elevated ESR depends on the underlying cause of the inflammation, which can be determined through a combination of clinical evaluation, laboratory tests, and imaging studies 2, 3.
- Treatment of the underlying condition, such as antibiotics for infections or disease-modifying antirheumatic drugs for autoimmune disorders, can help to reduce ESR values and alleviate symptoms 2, 3.